Percutaneous Lumbar Fixation Utilizing Pedicle Screws Versus Open Techniques: A Systematic Review

Abstract

Background: Percutaneous Pedicle screw fixation was introduced in 2002. It enables similar therapeutic efficacy to open techniques while having the advantage of minimal approach-related trauma and muscle stripping which translates to better clinical outcomes. This requires better imaging techniques and steeper learning curves compared to the open approach to lumbar pedicle screws. The aim of this study was to compare the therapeutic efficacy and clinical outcomes of the percutaneous approach to the open pedicle screw fixation approach. Methodology: This study is a systematic review of current literature comparing open and percutaneous approaches to the lumbar spine pedicle screw fixation. 20 studies were included. Results: Those who underwent the percutaneous lumbar pedicle screw fixation approach had shorter operation times, less bleeding intra- and post-operatively, lower Visual Analogue Scale (VAS) scores, lower Oswestry Disability Index (ODI) scores and shorter hospital stay compared to those who underwent the open approach. Conclusion: Both open and percutaneous approaches to lumbar pedicle screws have equal efficacy in placing the screws. The percutaneous approach can achieve these results with less approach-related morbidity and complications but has a steep learning curve and heavily depends on imaging.