General Session: MIS-3
Presented by: Y. Park - View Audio/Video Presentation (Members Only)
Y. Park(1), S.-O. Seok(2), S.-B. Lee(2), J.-W. Ha(2)
(1) National Health Insurance Service Ilsan Hospital, Yonsei University College of Medicine, Orthopedic surgery, Goyang, Korea, Republic of
(2) National Health Insurance Service Ilsan Hospital, Yonsei University College of Medicine, Goyang, Korea, Republic of
Background: Despite up-growing usage of percutaneous pedicle screw fixation as a standard method in the minimally invasive lumbar spinal arthrodesis, there has not yet been synthesized tangible evidence to establish the safety and efficacy of percutaneous pedicle screws comparing with conventional open screws. The purpose of this study was to determine comparative safety and effectiveness of percutaneous pedicle screw with open pedicle screw in the lumbar spinal fusion procedure.
Methods: A comprehensive search was performed in the PubMed, Ovid MEDLINE, and the Cochrane Library databases. Two independent reviewers selected all articles satisfying our inclusion and exclusion criteria and extracted relevant data of complications, subsequent surgical intervention, fusion rate, pain and function, and perioperative surgical data in adult patients undergoing lumbar spine fusion utilizing percutaneous or open pedicle screw instrumentation. Study quality was assessed using the methodological Index for Non-Randomized Studies (MINORS) scale and Harbord's modified test and Egger's test for small-study effects.
Results: Nine prospective comparative studies of low-quality (MINORS scale) were met our inclusion criteria. No randomized controlled trial was included in the review. Rates of complications (including neurological, hardware related, surgical-site complications, and pseudarthrosis) and subsequent surgical intervention (including revision, removal, reoperation, and supplemental fixation) were comparable between two groups. Percutaneous group showed an equivalent fusion rate and pain score improvement to the outcomes of open group. However, percutaneous group revealed a greater improvement of function score to that of open group (range, 5.0 - 1.5, p < 0.0001). Percutaneous group significantly exhibited less blood loss (292.9 - 246.2 ml, p < 0.0001), less postoperative analgesic need (40.2 - 21.9 mg, p < 0.0001), earlier ambulation (1.4 - 1.1 days, p < 0.0001), and shorter hospital stay (1.5 - 1.1 days, p < 0.0001) than open group. Percutaneous group significantly needed longer operation (26.2 - 15.9 minutes, p < 0.0001) and radiation exposure time (28.8 - 22.0 seconds, p < 0.0001) than open group.
Conclusions: Percutaneous pedicle screw fixation showed a similar safety and effectiveness to conventional open screw instrumentation when it used in stabilizing the lumbar spine for spondylolisthesis and spondylosis. On the other hand, percutaneous pedicle screw fixation revealed benefits in the blood loss, perioperative recovery, hospital stay, and functional improvement, but disadvantages in the operation and radiation exposure time over open procedure. However, the quality of the studies included in the current review precludes assured conclusions regarding the comparative safety and efficacy of percutaneous versus open pedicle screw fixation and further high quality studies are necessary.