One-step insertion of navigated pedicle screws in minimally invasive transforaminal lumbar interbody fusion (MITLIF): preliminary results of a novel technique

Abstract

Objective

To describe a novel technique modification and evaluate initial results of pedicle screw insertion in minimally invasive transforaminal lumbar interbody fusion (MITLIF), using self-drilling self-tapping one-step screws.

Patients and Methods

All patients who were operated for MITLIF using the one-step technique over the last 6 months period at a single institute, were retrospectively identified. The surgical technique is described and depicted. Outcome evaluation was performed, including screw misplacement, screw insertion time, and post-operative complications.

Results

We describe a novel technique modification in which self-drilling self-tapping navigated screws incorporate an embedded K-wire that enables a one-step insertion which obviates the need for instrument exchange. The first four patients in whom this technique was implemented were included (mean age was 55). All patients had been previously operated at the fused level. The mean surgical duration was 142 minutes and the calculated mean screw insertion time was 8.2 minutes. The mean estimated blood loss was 66 cc. An intraoperative 3D scan demonstrated no screw pedicle breach. There were no neurological complications or wound healing disturbances. The clinical course was uneventful for all patients.

Conclusion

To our knowledge, the use of one-step navigation-assisted self-drilling self-tapping pedicle screws with an embedded K-wire has not been previously described. Our initial experience with this novel technique modification was efficient and safe. Navigated surgery allows for newer and safer techniques to be incorporated into the surgeon’s toolbox. Further studies should be performed to thoroughly evaluate this technique.

Keywords:

• Spine surgery
• minimally invasive surgery
• one step screws
• TLIF
• navigated spine surgery
• pedicle Screws

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Disclosure statement

No potential conflict of interest was reported by the author(s).