Navigated minimally invasive facet fusion during percutaneous lumbar pedicle screw insertion: Technical note.

September 22, 2019

OBJECTIVE:

Minimally invasive surgery (MIS), or percutaneous, lumbar pedicle screw placement is commonly done, but the percutaneous nature of this makes posterior arthrodesis extremely difficult. Many times, surgeons will simply forego posterior arthrodesis, place posterior pedicle screws, and rely only on the interbody area for arthrodesis. We describe our technique of adding facet arthrodesis via the same corridor through which the pedicle screw is inserted with minimal addition of time or steps.

METHODS:

We demonstrate our technique of how we use navigation and tubular retractors to perform posterior facet arthrodesis during percutaneous pedicle screw placement. We illustrate this technique with a case of a patient with scoliosis, intraoperative photos, and an illustrative video. We also show an intraoperative computed tomography image to help visualize the arthrodesis surfaces. With this technique, we show how there are a few additional steps that are not very time consuming to add posterior arthrodesis.

RESULTS:

MIS facet fusion can be performed in a relatively straightforward manner during percutaneous pedicle fixation without significant addition of intraoperative time or steps.

CONCLUSIONS:

It is possible to add posterior arthrodesis to percutaneous lumbar pedicle screw fusion with few added steps and minimal addition of time using navigation and MIS tubular retractors.