A Novel Retractor for Reducing Operation Time and Radiation Exposure in Percutaneous Pedicle Screw Placement

To design a novel hand-held retractor in order to reduce both operation time and radiation exposure in percutaneous pedicle screw placement.

A total of 126 patients with single segment thoracolumbar vertebral fracture were surgically treated with percutaneous pedicle screws through our novel hand-held retractor technique (group A) or conventional fluoroscopic method (group B), the operation time and fluoroscopy shot times were compared, and the accuracy of screw placement were assessed.

There was no serious complications occurring during our study, such as infection, blood vessel injury, spinal cord or nerve root injury. We did not find any statistically difference between the two groups in corrected rate of regional Cobb?s angle or vertebral body height percentage (p > 0.05), however, the mean operation time was found to be 75.9 ± 2.37 min in the novel handheld retractor method group and 94.2 ± 2.19 min in the conventional method group. The difference was statistically significant (p?0.001). Fluoroscopy shot times averaged 9.01 ± 0.41 in the novel hand-held retractor group versus 16.8 ± 0.56 in the conventional group (p < 0.001), the novel hand-held retractor group had apparent advantages over the conventional method in postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI) at 2 days, 3 months after operation and last follow-up (p < 0.05). There was no statistical difference between group A and B in the radiographic results and screw position violation grade.

The novel hand-held method retractors have several advantages, including shorter operation time, less fluoroscopy shot times, and better postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI). It provides a new alternative method for effective management of thoracolumbar fractures.