title: Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires: clinical article.
abstract: OBJECTIVE
  Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires.
  
  
  METHODS
  Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement.
  
  
  RESULTS
  On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures.
  
  
  CONCLUSIONS
  Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gianaris
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Helbig
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horn
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails / Q000706:statistics & numerical data; D001863:Bone Screws / Q000592:standards / Q000706:statistics & numerical data*; D001864:Bone Wires / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome