Abstract
Background and Study Aim
In contrast to the thoracolumbar spine, where pedicle screws can be inserted via a
minimally invasive, percutaneous technique through small skin incisions, all previously
available cervical instrumentation systems required a larger midline incision, especially
for rod insertion. Screw placement via small incisions reduces the risk of wound healing
disorders and blood loss, and patients can be mobilized more quickly and with less
pain. In 2022, a cervical, minimally invasive stabilization system became available
for the complete percutaneous insertion of both cervical pedicle screws and rods.
We report on the first results and experiences with this new technology.
Methods
In this retrospective case series, we included patients with cervical instability
treated by minimally invasive percutaneous cervical and upper thoracic spine pedicle
screw and rod insertion between August 2022 and August 2023. Intra- and postoperative
complications as well as revision surgeries were recorded. The screw position was
evaluated by three examiners in the postoperative computed tomography (CT) using the
Bredow classification.
Results
Our series includes six male patients (age = 56.9 ± 12.9 years; body mass index [BMI] = 29.8 ± 9.6 kg/m2). The indication for surgery was trauma, tumor, and degenerative stenosis in two
patients each. An excellent/good screw position (Bredow 1 and 2) was found in 84.4%
of the screws (n = 27/32). None of the screws rated as Bredow 3 (n = 2/32) or Bredow 4 (n = 3/32) resulted in a neurological deficit or radicular pain and none had to be repositioned.
No neurologic complication or revision surgery occurred. As a complication not directly
related to the surgery technique, one patient died of a pulmonary lung embolism on
the seventh postoperative day.
Conclusion
The results of this study indicate that minimally invasive percutaneous implantation
of a pedicle screw–rod system is also possible in the cervical spine with sufficient
accuracy using intraoperative navigation. However, technical details, possible pitfalls
and finally careful patient selection must be taken into account.
Keywords
cervical spine - minimally invasive - navigation - pedicle screws - spinal instability
