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Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide

INTRODUCTION: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoid...

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Autores principales: Koakutsu, Tomoaki, Aizawa, Toshimi, Itoi, Eiji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Spine Surgery and Related Research 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661024/
https://www.ncbi.nlm.nih.gov/pubmed/33195862
http://dx.doi.org/10.22603/ssrr.2019-0114
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author Koakutsu, Tomoaki
Aizawa, Toshimi
Itoi, Eiji
author_facet Koakutsu, Tomoaki
Aizawa, Toshimi
Itoi, Eiji
author_sort Koakutsu, Tomoaki
collection PubMed
description INTRODUCTION: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system. TECHNICAL NOTE: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion. Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately. CONCLUSIONS: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments.
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spelling pubmed-76610242020-11-13 Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide Koakutsu, Tomoaki Aizawa, Toshimi Itoi, Eiji Spine Surg Relat Res Technical Note INTRODUCTION: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system. TECHNICAL NOTE: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion. Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately. CONCLUSIONS: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments. The Japanese Society for Spine Surgery and Related Research 2020-02-26 /pmc/articles/PMC7661024/ /pubmed/33195862 http://dx.doi.org/10.22603/ssrr.2019-0114 Text en Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research https://creativecommons.org/licenses/by-nc-nd/4.0/ Spine Surgery and Related Research is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Technical Note
Koakutsu, Tomoaki
Aizawa, Toshimi
Itoi, Eiji
Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title_full Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title_fullStr Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title_full_unstemmed Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title_short Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
title_sort accurate and minimally invasive cervical pedicle screw insertion procedure using the bone biopsy needle as drill guide
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661024/
https://www.ncbi.nlm.nih.gov/pubmed/33195862
http://dx.doi.org/10.22603/ssrr.2019-0114
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