Percutaneous Pedicle Screw Fixation Technique in the Thoracic and Lumbar Spine-Tips and Tricks

The need for spinal fixation in patients who cannot tolerate classical open surgery has led in recent years to the development of minimally invasive approaches. The use of percutaneous pedicle screw fixation offers several advantages, such as less blood loss and postoperative pain due to blunt separation of the muscles with reduction of soft tissue dissection. Medical records and demographic information, diagnosis, and preoperative pain levels of 63 patients who underwent percutaneous minimally invasive thoracolumbar spine stabilization using the Illico® Fixation System (Alphatec Spine, Carlsbad, California) were analysed: a total of 344 screws were implanted. Preoperative and postoperative clinical assessment of the patients were based on a visual analogue scale. Because percutaneous techniques do not allow gross visualization of the vertebra and erroneous placement of the screw may be high in the initial cases, we discuss the techniques for a safe implantation of pedicle screws using a single or double intraoperative fluoroscopy. We report tips and tricks for technical challenges including fixation in osteoporotic patients, percutaneous insertion of long rods, compression/distraction using multiaxial screws turning into monoaxial, and use of minimally invasive retractror for interbody fusion. Recently, indications for minimally invasive percutaneous fixation have expanded and my results support that it may be considered a safe and effective option for the treatment of degenerative and traumatic thoracolumbar spinal diseases.