Percutaneous Lumbar Pedicle Screw Insertion

Percutaneous pedicle screw fixation is a viable alternative to the traditional open technique. It can be applied to virtually any case where conventional open procedures are indicated. Advantages of this minimally invasive approach include the potential to insert screw in a more ideal trajectory, avoidance of supradjacent facet violation, shorter hospital stay, reduced blood loss, decreased postoperative opioid use, and generally faster postsurgical recovery. Lack of direct visualization of osseous structures can be challenging to a surgeon who is new to the technique. Performing this procedure requires the use of intraoperative imaging tools. We describe 2 commonly used imaging techniques: 2-dimensional fluoroscopy and 3-dimensional image guidance techniques. Debate still exists on whether use of the latter technology results in increased radiation exposure. This article provides step-by-step procedures in lumbar percutaneous screw insertion using the aforementioned imaging techniques.