Percutaneous pedicle screw fixation [Neurosurgery Wiki]

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====== Percutaneous pedicle screw fixation ======

===== Indications =====

Percutaneous [[pedicle screw placement]]

[[Vertebroplasty]]/[[Kyphoplasty]]

Percutaneous [[biopsy]] of pathology in the [[pedicle]] and/or [[vertebral body]]
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1.- Requires AP and lateral fluoroscopy, or [[O Arm]] imaging.

Acquiring two simultaneous images from two orthogonal planes has been reported to be more efficient than single-plane imaging.

2.- Can be employed from T1 through S1 as long as adequate AP & lateral imaging of the involved level is possible.

Upper thoracic placement (above [[T5]]) is challenging [[shoulder]] interference small [[pedicle]]s.

3.- The skin entry site is lateral to the lateral edge of the [[pedicle]]. This permits the needle to pass through the pedicle off the midline for the entry site depending on the vertebral level being accessed (thoracic pedicles are oriented in a more AP direction, lumbar pedicles angulate medially inward) as well as the amount of overlying muscle/fat.

===== Case series =====

Forty patients with thoracic and lumbar metastatic tumors were treated with PPSF combined with PVP and followed up for 6-33 months. The [[visual analog scale]] (VAS) and the [[Barthel Index]] of activities of daily living (BIADL) were used to evaluate the pain intensity and [[quality of life]] before surgery and at 7 days, 3 months, and 6 months after the treatment.

Results: In this study, a total of 40 patients were followed up for 6-33 months (the meantime was 14.87 months). The VAS scores of all patients were significantly decreased, while the BIADL scores were significantly increased. No patients suffered from complications such as infection, pedicle screw loosening, or polymethylmethacrylate leakage. Spine stability was observed in all surviving patients during the follow-up.

Conclusions: PPSF combined with PVP is a new and viable treatment for thoracolumbar metastases in patients with a poor systemic condition, patients who refuse to undergo a conventional open procedure such as en bloc corpectomy, and in patients with vertebral instability or pathological fracture without significant spinal compression.

Relevance for patients: Patients with [[spinal metastases]] have a great risk of [[spinal instability]] and even [[spinal cord compression]] while enduring [[pain]]. Therefore, timely and appropriate surgical treatment is an effective means to stabilize the spine and avoid spinal cord compression. PPSF combined with [[percutaneous vertebroplasty]] is an effective new surgical method for the treatment of multilevel spinal metastases
((Ma X, Zhao Y, Zhao J, Wu H, Feng H. Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracic and lumbar metastatic tumors. J Clin Transl Res. 2023 Feb 14;9(2):93-100. PMID: 37033999; PMCID: PMC10075092.)).
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[[Survival]] of [[cancer]] [[patient]]s continues to improve with [[systemic treatment]] advancements, leading to an increase in cancer-related complications such as pathological [[spinal fracture]]s. In a study, Meleis et al. aimed to evaluate the [[outcome]] of [[percutaneous]] [[stabilization]] with [[cement augmentation]] of the [[pedicle screw]]s in the [[management]] of patients with metastatic cancer to the [[spine]].

They reviewed a [[retrospective]] [[case series]] of 74 patients with symptomatic pathological [[spine fracture]]s treated with cement-augmented pedicle screws implanted with a percutaneous technique. The mean imaging follow-up was 11.3 months. Data on demographics, clinical outcomes, and complications were collected. Cement extravasation, spinal hardware integrity, and fusion rates were assessed on CT scans.

Among 50 patients with follow-up imaging, 23 patients (46%) showed facet joint fusion. The length of segmental stabilization was not a significant predictor of the occurrence of [[fusion]]. Pre- or postoperative [[radiation therapy]], postoperative [[chemotherapy]], and the location of spinal lesions did not have a statistically significant effect on the occurrence of fusion. Patients older than 60 years of age were more likely to have fusion across [[facet joint]]s compared with younger patients. There was a significant difference in the mean visual analog scale pain score, with 6.28 preoperatively and 3.41 postoperatively, regardless of fusion status (p < 0.001). Cement extravasation was seen in 51% of the cohort, but in all instances, patients remained asymptomatic. Most importantly, the incidence of hardware failure was low (4%).

Percutaneous fixation with cement-augmented [[pedicle screw]]s in patients with pathological spine fractures provides an improvement in mechanical back pain, with a low incidence of failure, and in some patients, spontaneous facet fusion was observed. Further research is necessary with regard to both short-term benefits and long-term outcomes
((Meleis A, Larkin MB, Bastos DCA, Muir MT, Rao G, Rhines LD, Cowles CE, Tatsui CE. Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur? Neurosurg Focus. 2021 May;50(5):E9. doi: 10.3171/2021.1.FOCUS20671. PMID: 33932939.)).

===== Minimally invasive percutaneous pedicle screw fixation =====


[[Minimally invasive percutaneous pedicle screw fixation]]