Preliminary Report On Percutaneous Transpediculr Screw Instrumentation Combined With Minimal Alif Approach

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Josip Buric


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Domenico Bombardieri


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Luca Corò


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Citation: J. Buric, D. Bombardieri & L. Corò : Preliminary Report On Percutaneous Transpediculr Screw Instrumentation Combined With Minimal Alif Approach. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

Objective: This study was performed to compare the minimally invasive circumferential fusion to standard open circumferential fusion for low back pain in lumbar degenerative disc disease. Background: Standard open circumferential fusion is associated with better clinical and radiological results than PLIF or TLIF fusion procedures but has a higher degree of intraoperative and post-operative complications. Minimally invasive ALIF combined with percutaneous transpedicular screw instrumentation has the potential of reducing the disadvantages of the procedure. Methods: Eighteen patients affected by low back and leg pain due to degenerative disc disease from L3 to S1 levels were submitted to the operation during 2007 year using this minimally invasive approach. Posterior part of the procedure was performed using the percutaneous transpedicular screws (Pathfinder, Abbott Spine) while the ALIF was performed in a minimally invasive retroperitoneal way implanting anterior full-body cage (Perimeter, Medtronic). Results: All of 18 patients improved upon surgery. The mean improvement was of 5,7 points on VAS scale and 7 points on the Roland Morris Disability Questionnaire. The mean operating time for the posterior part of the procedure (skin to skin) was as follows: 50 minutes for one level and 80 minutes for two levels. The mean operating time for the anterior approach was 90 minutes for one level and 110 minutes for two levels. The total amount of time for both approaches, including the turn-up time for patient repositioning ranged from 160 minutes for one level till 300 minutes for double level. No major complications due to vascular rupture or peritoneal damage were encountered. As well, a nerve root damage was ever found. The mean blood loss per surgery was approximately 250 milliliters and in no patient blood transfusion was indicated. Surgical wound drainage was never used. All the patients were raised from the bed between 12 to 18 hours after the surgery. The longest hospital stay was 6 days. As compared to standard circumferential fusion, the reported post-operative pain was 3-fold less and the use of post-operative opioids and pain killers was 60% less. No wound or systemic infection was ever encountered. There were no complications observed due to pulmonary embolism. Conclusion: Minimally invasive ALIF combined with posterior percutaneous transpedicular screw instrumentation seems an equally useful system as compared to standard open circumferential fusion with the advantage of less blood loss, fewer complication rate, shorter operation time and shorter hospital stay. Longer follow-up is mandatory to verify clinical and radiological results.

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