Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1
Schematic and equipment for “K-wireless” navigated minimally invasive pedicle screw placement: “awl-tipped tap” that allows for penetration of the cortical bone at the screw entry site, initial passage into the pedicle, and tapping through the pedicle into the vertebral body. This tap changes from a small to larger diameter along its shaft, and we prefer the 4.5- to 5.5-mm option for lumbar pedicle screws. This instrument is inserted with a low-speed/high-torque Powerase driver. All cases were performed using the O-arm cone beam computed tomography intraoperative imaging system integrated with the StealthStation navigation system and Medtronic instrumentation. Registration is automatic with this system.
Download figure
Open in new tab
Download powerpoint
Figure 2
Intraoperative pictures and with corresponding neuronavigation for “K-wireless” navigated pedicle screw placement. (A) Navigation is used to mark the incision providing the desired convergent trajectory through the pedicle, minimizing the size of the incision needed. (B) The “awl-tipped tap” is used to make a trajectory plan or “virtual K-wire,” followed by tapping of the pedicle, aided by the saved trajectory plan, without the need for pilot holes. (C) Screw placement is aided by the saved trajectory plan. (D) This is repeated for each subsequent pedicle screw. (E) Percutaneous rod placement.