Percutaneous Lumbar Fixation

Abstract

SUMMARY T he use of pedicle screws for spinal stabilization has become increasingly popular worldwide. Pedicle screw systems engage all three columns of the spine and can resist motion in all planes. Several studies suggest that pedicle screw fixation is a safe and effective treatment for many spinal disorders. Lumbar interbody fusion is also a recognized surgical technique in treatment of degenerative lumbar instability. Interbody fusion supplemented with pedicle screw fixation has several advantages over posterolateral fusion and has been advocated to improve fusion rates and clinical outcomes. Interbody fusion places the bone graft in the load-bearing position of the anterior and middle spinal columns therefor enhancing the potential for fusion. In addition, the interbody space has more vascularity than the posterolateral space, also increasing the potential for a solid fusion mass to form. Surgical procedures that include both posterolateral and interbody fusion have demonstrated high fusion rates and good clinical results. These procedures have distinct advantages including anterior column load sharing, large surface areas for fusion, restoration of a normal sagittal profile, and the achievement of passive foraminal decompression. Transforaminal posterior approach (transforaminal lumbar interbody fusion (TLIF) was first described by Harms and Rolinger in 1982. Using a transforaminal approach via osteotomy of the pars interarticularis and inferior articular facet allows for access to the disc space with minimal retraction of the neural elements, avoids the morbidity of an anterior approach, and has a lower complication rate than direct posterior lumbar interbody fusion. The posterior unilateral transforminal approach also allows the surgeon to address all of these issues concurrently via one approach without the need of a second anterior incision and its associated morbidity and complications (particularly vascular complications in all patients and retrograde ejaculation in male patients). The percutaneous technique allows the surgeon to perform biomechanically sound internal spinal fixation with minimal tissue trauma and less intraoperative bleeding, less hospital stay and less back pain with the ability to get back to his/her normal life and activity faster than others performed through the open technique. The minimally invasive techniques are performed addressing several advantages as mentioned before but to reach this results it needs years of practice performing these techniques to have experience and skills . The surgeon performing a TLIF is able to address a wide variety of spinal pathologic processes and also obtain a reproducible and consistently high rate of successful arthrodesis while decompressing stenosis of the lateral canal and neural foramen. By utilizing a unilateral approach, the contralateral lamina/facet complex remains intact, thus decreasing perineural scarring and providing more surface area for posterolateral fusion.