title: "NIMS technique" for minimally invasive spinal fixation using non-fenestrated pedicle screws: A technical note.
abstract: METHODS
  Case series.
  
  
  OBJECTIVE
  To reduce the cost of minimally invasive spinal fixation.
  
  
  BACKGROUND
  Minimally invasive spine (MIS) surgery is an upcoming modality of managing a multitude of spinal pathologies. However, in a resource-limited situations, using fenestrated screws (FSs) may prove very costly for patients with poor affordability. We here in describe the Nizam's Institute of Medical Sciences (NIMS) experience of using routine non-FSs (NFSs) for transpedicular fixation by the minimally invasive way to bridge the economic gap.
  
  
  METHODS
  A total of 7 patients underwent NFS-minimally invasive spine (MIS) surgery. Male to female distribution was 6:1. The average blood loss was 50 ml and the mean operating time was 2 and 1/2 h. All patients were mobilized the very next day after confirming the position of implants on X-ray/computed tomography.
  
  
  RESULTS
  All 7 patients are doing well in follow-up with no complaints of a backache or fresh neurological deficits. There was no case with pedicle breach or screw pullout. The average cost of a single level fixation by FS and NFS was ₹1, 30,000/patient and ₹32,000/patient respectively ('2166 and '530, respectively). At the end of 1-year follow-up, we had two cases of screw cap loosening and with a displacement of the rod cranio-caudally in one case which was revised through the same incisions.
  
  
  CONCLUSIONS
  Transpedicular fixation by using NFS for thoracolumbar spinal pathologies is a cost-effective extension of MIS surgery. This may extend the benefits to a lower socioeconomic group who cannot afford the cost of fenestrated screw (FS).
authors.affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Alugolu
authors.initials: A
authors.lastname: Rajesh
authors.affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Pavan Kumar
authors.initials: PK
authors.lastname: Pelluru
authors.affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
keywords: Cost-effective; fenestrated screws; minimally invasive; non-fenestrated screws; pedicle fixation