Fluoroscopy-based percutaneous posterior screw placement in the lateral position using the tunnel view technique:...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Lateral single position surgery (LSPS) is increasingly used for lumbar fusion.
• Percutaneous pedicle screw placement in the lateral position presents significant technical challenges.

Purpose of the Study:

• To describe a fluoroscopy-navigated technique for lateral percutaneous pedicle screw placement.
• To detail the tunnel view technique for simplifying screw insertion in LSPS.

Main Methods:

• Detailed description of the tunnel view technique, including radiologic principles.
• Explanation of patient and C-arm positioning for optimal visualization.
• Surgical technique for Jamshidi needle and screw placement under fluoroscopy.

Main Results:

• The tunnel view technique has been the standard for pedicle screw placement since 2017.
• A 0% reoperation rate for symptomatic malpositioned pedicle screws has been achieved.
• The technique allows continuous monitoring of pedicle walls and screw intrapedicular placement.

Conclusions:

• The tunnel view technique simplifies lateral percutaneous pedicle screw placement.
• It enhances safety by allowing constant observation of critical anatomical structures.
• The technique is safe, feasible, and effective in clinical practice.