A More Efficient and Safer Improved Percutaneous Pedicle Screw Insertion Technique-Trajectory Dynamic Adjustment...

Area of Science:

• Spinal Surgery
• Orthopedic Surgery
• Minimally Invasive Procedures

Background:

• Traditional percutaneous pedicle screw fixation (PPSF) necessitates precise needle placement, often leading to adjustments, pedicle damage, and increased radiation.
• The limitations of PPSF highlight the need for improved techniques in spinal stabilization.

Purpose of the Study:

• To introduce and evaluate the feasibility of the trajectory dynamic adjustment (TDA) technique for percutaneous pedicle screw fixation.
• To compare the clinical outcomes of the TDA technique against the traditional PPSF method.

Main Methods:

• A retrospective study of 445 patients with lumbar spondylolisthesis or spinal stenosis was conducted between June 2017 and May 2022.
• Patients were randomized into two groups: TDA technique (231 patients) and traditional PPSF (214 patients).
• Outcomes assessed included screw placement accuracy, facet joint violation (FJV), needle insertion time, radiation exposure, blood loss, hospital stay, JOA scores, VAS pain scores, fusion rates, and complications.

Main Results:

• The TDA group demonstrated significantly shorter needle insertion times and reduced fluoroscopy frequency compared to the PPSF group.
• While lateral screw misplacement was higher in the TDA group, the facet joint violation (FJV) rate was significantly lower.
• Both groups showed significant improvements in postoperative pain and JOA scores, with no significant differences in overall fusion rates or complications.

Conclusions:

• The TDA technique is a safer and more effective alternative to traditional PPSF for lumbar spinal surgery.
• Key advantages of TDA include reduced surgical time, lower radiation exposure, and a decreased rate of facet joint violations.
• The TDA technique shows promise for improving patient safety and surgical efficiency in percutaneous pedicle screw fixation.