General Session: Endoscopic Surgery
Presented by: K. Radcliff - View Audio/Video Presentation (Members Only)
K. Radcliff(1), B. Woods(1), H. Smith(2), B. Kalantar(3), J. Brannon(4)
(1) Rothman Institute, Thomas Jefferson University, Department of Orthopedic Surgery, Egg Harbor, NJ, United States
(2) University of Pennsylvania, Philadelphia, PA, United States
(3) Georgetown University, Washington, DC, United States
(4) Orthopedic Sciences, Inc, Seal Beach, CA, United States
Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches.
Methods: A live porcine model was used in conjunction with an approved university veterinary protocol. Eight lumbar pedicles were cannulated and the integrity was documented by palpation in the standard manner. Clinically significant breaches were created. An endoscope was introduced and was used to inspect the pedicles visually.
Results: All lumbar pedicles were endoscopically visible at a systolic pressure of 100 mm Hg. Clinically relevant anatomic structures and iatrogenic pathology, such as medial, lateral, and anterior breaches, were identified. The endoscope was utilized concurrently with a ball-tip probe to visualize the findings upon palpation. The endoscope was utilized with a guidewire to visualize potential screw trajectories. There were no untoward events resulting from endoscopic inspection of the pedicle endosteal canal.
Discussion: To the author's knowledge, this is the first report of low pressure endoscopic inspection of pedicle wall integrity to assist in screw placement. Endoscopic inspection of lumbar pedicles was safe and effective. The findings on endoscopic inspection corresponded with the ball-tip probe palpation techniques. Additional techniques, such as selection between two tracts, was possible with the endoscopic technique. Endoscopic pedicle tract inspection may be additional technology to enable surgeons to place pedicle screws more safely and effectively.