Minimally invasive pedicle screw placement with image-guided navigation in cervical spine injuries

Introduction

MIS pedicle screw placement is a novel technique for the management of unstable injuries of the cervical spine. This study aims to evaluate the feasibility of MIS pedicle screw placement and to compare perioperative, postoperative and radiological outcomes between MIS and conventional open approaches.

Methods

This single-centre cohort study included patients with unstable injuries of the cervical spine treated with open approaches for pedicle or lateral mass screw fixation or MIS approaches for pedicle screw fixation. Perioperative and postoperative variables were compared. All screw positions were classified according to the Bredow classification.

Results

Twenty patients with unstable injuries of the cervical spine were included, 10 undergoing conventional open posterior fixation (87 screws) and 10 undergoing MIS cervical pedicle screw fixation (48 screws). In the MIS group, significantly fewer vertebrae were instrumented (2.4 vs. 4.5; p = 0.008) and significantly fewer screws placed (4.8 vs. 8.7; p = 0.009). Operative time was significantly shorter in patients operated with MIS approach (183 vs. 132 min; p = 0.020). Also, there was a significant reduction in blood loss per surgery in patients operated with a MIS approach compared to an open approach (145 vs. 891 ml; p = 0.002). Out of 87 pedicle and lateral mass screws placed with an open approach 99% were classified as Bredow grade 1 or 2. All 48 screws placed with a MIS approach were rated as Bredow grade 1 or 2.

Conclusions

This feasibility study provides preliminary evidence that surgery with MIS approach with navigated pedicle screws may be associated with reduced length of surgery and intraoperative blood loss compared to open surgery. Radiological evaluation of screw placement showed a good positioning with both open and minimally invasive approach. The results highlight the need for further investigation in larger, controlled trials to more rigorously evaluate the potential benefits and risks of this approach.