title: Technique, challenges and indications for percutaneous pedicle screw fixation.
abstract: Minimally invasive techniques in spinal surgery are increasing in popularity due to numerous potential advantages, including reduced length of stay, blood loss and requirements for post-operative analgesia as well as earlier return to work. This review discusses guidelines for safe implantation of percutaneous pedicle screws using an image intensifier technique. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery technique will also expand. It is paramount that experienced surgeons share their collective knowledge to assist surgeons at their early attempts of these complex, and potentially dangerous, procedures. Technical challenges of percutaneous pedicle screw fixation techniques are also discussed including: small pedicle cannulation, percutaneous rod insertion for multilevel constructs, incision selection for multilevel constructs, changing direction with percutaneous pedicle screw placement, L5/S1 screw head proximity and sclerotic pedicles with difficult Jamshidi placement. We discuss potential indications for minimally invasive fusion techniques for complex spinal surgery and support these with descriptions of illustrative patients.
authors.affiliation: Department of Neurosurgery, Prince of Wales Private Hospital, Sydney Spine Clinic, Randwick, New South Wales 2031, Australia. ralphmobbs@hotmail.com
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
authors.forename: Praveenan
authors.initials: P
authors.lastname: Sivabalan
authors.forename: Jane
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000368:Aged; D001863:Bone Screws; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D013122:Spinal Diseases / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome