BACKGROUND:

Pedicle screw insertion is a common procedure in spine surgery, and freehand, fluoroscopic, and robotic-assisted techniques are all utilized. These are indirect methods that utilize fluoroscopy, and direct visualization of canal involvement has not been possible. However, owing to the development of high-definition imaging modalities, delicate procedures that utilize endoscopy are possible.

CASE DESCRIPTION:

Herein we describe a 47-year-old male patient who presented with severe radiating pain in his leg after undergoing lumbar 5 to sacrum 1 level endoscopic transforaminal lumbar interbody fusion and percutaneous pedicular screw fixation. The patient then underwent endoscopic-assisted technique for violated spinal canal and screw revision, wherein the misplaced screw was directly visualized using endoscopy and the trajectory of the misplaced screw was changed. With 30° endoscopy, we could directly visualize the screw thread and root compression. Then, with 0° endoscopy, we could change screw trajectory inside the pedicle with an anatomic landmark. The patient’s radiating pain was completely relieved after revision of the malpositioned screw. Postoperative imaging showed the revised screw trajectory inside the pedicle.

CONCLUSIONS:

Endoscopic-assisted pedicle screw insertion does not require an additional incision, and early recovery after the procedure is possible. Furthermore, accurate diagnosis of canal pathology and treatment are possible with direct visualization using endoscopy.

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