Clinical evaluation of percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance

English Keywords:Anterior-posterior fluoroscopic imaging  Percutaneous pedicle screw  Lumbar spine

English Abstract:

  【Abstract】 Objectives: To evaluate effectiveness and safety of percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance. Methods: From October 2011 to June 2013, 40 cases suffering fromlumbar degenerative diseases were included in this study. 20 of them underwent percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance(observational group). While the other 20 patients underwent percutaneous pedicle cannulation and screws insertion(one level) by routine anterior-posterior and lateral fluoroscopic imaging guidance(control group). For these 40 cases, bilateral pedicle lengths of five lumbar vertebrae(from L1 to L5) and sacrum 1(S1) were measured by using transverse computed tomography(CT) images before operation. Their arithmetic mean value was calculated as the reference of cannulation length. Time length, intraoperative radiation exposure time, dose area product, skin irradiation dose during pedicle cannulation and intraoperative complication of patients in both groups were recorded and analyzed. Ultrathin spiral CT was used to confirm the accuracy of pedicle screw insertion in both groups. Results: Pedicle length from L1 to S1 was 19.7±0.6mm, 19.6±0.6mm, 19.0±0.8mm, 18.8±0.8mm, 18.4±0.8mm, 16.3±1.3mm respectively among 40 cases. 160 pedicle screws were safely inserted, and no intraoperative complication related with cannulation was noted. Time length, intraoperative radiation exposure time, dose area product and skin irradiation dose during pedicle cannulation in observational group were lower than those in control group(P<0.05). 1 case in observational group and 2 cases in control group experienced pedicle perforation, which was revealed by ultrathin spiral CT postoperatively. However, there was no statistical significance(P>0.05). Conclusions: Percutaneous pedicle cannulation simply under anterior-posterior fluoroscopic imaging guidance is of high safety, simplified manipulation, decreased radiation exposure, which appears to be a favorable alternative option.