Complications with K-wire insertion for percutaneous pedicle screws

Retrospective study.

To determine the risk profile and complications associated with anterior vertebral body breach by Kirschner (K)-wire during percutaneous pedicle screw insertion.

Percutaneous techniques and indications are rapidly expanding with numerous studies now supporting the use of percutaneous pedicle screw stabilization as an adjunct for multiple pathologies such as degenerative, tumor, and trauma. With regards to complication rates, little has been documented.

A total of 525 consecutive percutaneous pedicle screws were retrospectively reviewed and the rate of anterior vertebral body breach was recorded, including any potential adverse clinical outcomes.

Of 525 percutaneous pedicle screw insertions, there were 7 anterior breaches recorded. We rated the breaches as a minor breach (<5 mm; n=3), moderate breach (5-25 mm; n=2), and major breach (>25 mm; n=2). Two patients had a postoperative ileus with a retroperitoneal hematoma on postoperative computed tomography scan. No patient required reoperation or blood transfusion.

The indications for minimally invasive spinal fusion have expanded to include conditions such as degenerative, trauma, deformity, infection, and neoplasia. Although the rate of anterior K-wire breach is low, the technique requires the acquisition of a new set of skills including the safe passage of a K-wire, and knowledge of potential complications that may ensue.