Accuracy of fluoroscopic guidance with the coaxial view of the pedicle for percutaneous insertion of lumbar pedicle screws and risk factors for pedicle breach

Koichi Murata MD, PhD, Shunsuke Fujibayashi MD, PhD, Bungo Otsuki MD, PhD, Takayoshi Shimizu MD, PhD, Kazutaka Masamoto MD and Shuichi Matsuda MD, PhD
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  • Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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OBJECTIVE

In this study the authors aimed to evaluate the rate of malposition, including pedicle breach and superior facet violation, after percutaneous insertion of pedicle screws using the coaxial fluoroscopic view of the pedicle, and to assess the risk factors for pedicle breach.

METHODS

In total, 394 percutaneous screws placed in 85 patients using the coaxial fluoroscopic view of the pedicle between January 2014 and September 2017 were assessed, and 445 pedicle screws inserted in 116 patients using conventional open procedures were used for reference. Pedicle breach and superior facet violation were evaluated by postoperative 0.4-mm slice CT.

RESULTS

Superior facet violation was observed in 0.5% of the percutaneous screws and 1.8% of the conventionally inserted screws. Pedicle breach occurred more frequently with percutaneous screws (28.9%) than with conventionally inserted screws (11.9%). The breaches in percutaneous screws were minor and did not reduce the interbody fusion rate. The angle difference between the percutaneous and conventionally inserted screws was comparable. Insertion at the L3 or L4 level, right-sided insertion, placement around a trefoil canal, smaller pedicle angle, and a small difference between the screw and pedicle diameters were found to be risk factors for pedicle breach by percutaneous pedicle screws.

CONCLUSIONS

Percutaneous pedicle screw placement using the coaxial fluoroscopic view of the pedicle carries a low risk of superior facet violation. The screws should be placed carefully considering the level and side of insertion, canal shape, and pedicle angle.

ABBREVIATIONS AP = anteroposterior; MPR = multiplanar reconstruction; OLIF = oblique lateral interbody fusion.

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Contributor Notes

Correspondence Koichi Murata: Kyoto University Graduate School of Medicine, Kyoto, Japan. kchm@kuhp.kyoto-u.ac.jp.

INCLUDE WHEN CITING Published online August 28, 2020; DOI: 10.3171/2020.5.SPINE20291.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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