Percutaneous computer-assisted translaminar facet screw: an initial human cadaveric study.

Area of Science:

• Spinal surgery
• Minimally invasive techniques
• Image-guided procedures

Background:

• Translaminar facet screws represent a minimally invasive approach for posterior lumbar fixation with established success rates.
• Computer-assisted virtual fluoroscopy enables multi-planar visualization for planning and guiding spinal instrumentation.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous translaminar facet screw placement using virtual fluoroscopy for image guidance.

Main Methods:

• A human cadaveric study involving bilateral placement of ten translaminar facet screws at five lumbar levels.
• Percutaneous reference frame applied to the iliac crest, with navigation via anteroposterior and lateral virtual fluoroscopy.
• Post-placement computed tomography scans for grading screw entry, trajectory through the lamina, and final terminus.

Main Results:

• All screw entry points were optimally positioned at the spinous process laminar junction.
• Five screws achieved Grade 0 placement (fully within lamina), and five achieved Grade I (less than half through lamina).
• No screws jeopardized the spinal canal or exiting nerve roots; termination points were acceptable in five cases.

Conclusions:

• Virtual fluoroscopy significantly assists in the percutaneous placement of translaminar facet screws.
• The technique ensures safe positioning regarding screw entry, trajectory through the lamina, and final terminus.