Clinical applicability of percutaneous cervical pedicle screws: a retrospective matched-pair study

Although minimally invasive techniques are established in thoracolumbar spine surgery, their benefit and applicability in cervical spine surgery still require further validation. This study aimed to investigate feasibility and screw accuracy, as well as paraspinal muscle atrophy, in the authors' initial patient cohort of subaxial percutaneous navigated cervical screw-rod instrumentation through a retrospective matched-patient analysis.

The patients of the percutaneous group (PG) (n = 20) were matched with the patients of the conventional group (CG) who underwent the midline approach (n = 20) on the basis of total instrumented segments, level of instrumentation, age, and sex. Pedicle screw accuracy was assessed using the Bredow classification and cross-sectional muscle areas were compared preoperatively and at a minimum follow-up of 60 days.

Surgical indications were primarily degenerative in the CG (70%) and more diverse in the PG (40% degenerative, 35% oncological, and 20% traumatic). The percutaneous system was more frequently used in combined anterior-posterior approaches (50% PG vs 35% CG). Skin incision to navigation time was significantly shorter in the PG (mean ± SD 14 ± 15 minutes vs 44 ± 23 minutes in the CG), while screw placement time and clinically acceptable postoperative screw accuracy (88% PG vs 95% CG) were comparable. After a median follow-up of 140 days, muscle area change was without relevant differences (99.1% PG vs 93.7% CG), and no neurovascular injuries occurred in either group.

Percutaneous cervical screw-rod instrumentation using navigated pedicle screws is a versatile tool offering comparable accuracy. Besides the advantages of shorter preparation time and applicability in combined approaches, the real benefits of muscle preservation need to be proven in larger prospective patient cohorts.