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Spinal Fusions Using Standard Pedicle Screw and Lateral Mass Spinal Fixation

Minimally Invasive Pedicle Screw Instrumentation

The spine is made up of small bony segments called vertebrae. Vertebrae are categorized into cervical or neck vertebrae, thoracic (upper back), lumbar (lower back) and sacrum. This stack of bones is protected by the cushioning effects of intervertebral discs. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body to provide voluntary movement and sensation.

The spine consists of the lamina which forms the roof and back of the spinal canal, and the pedicle which joins the lamina to the vertebral body to form the vertebral arch.

Aging and trauma can damage the intervertebral discs, causing the bones to painfully rub against each other and compress the nerves that pass through them. Your doctor may recommend a spinal fusion procedure, where the diseased bones are fused and supported with screws through a minimally invasive surgery called pedicle screw instrumentation.

Indications

Minimally invasive pedicle screw instrumentation is a procedure performed along with another procedure called spinal fusion. Conditions such as degenerative disc disease, scoliosis, spondylolisthesis, spinal instability, and fractures can be treated through this procedure.

Surgical procedure

Spinal fusion is a procedure during which your doctor fuses your diseased vertebrae together thereby preventing motion at that vertebral segment.

Pedicle screws used during a spinal fusion surgery provide a means for gripping onto a vertebral segment and limiting its motion. The instrumentation also provides additional support and stability while the bones are fusing together.

During minimally invasive pedicle screw instrumentation, you will be given general anesthesia, which means you will sleep throughout the entire procedure. You will lie on your stomach during the surgery. The skin on your back will be cleansed with antibiotic solution. Your surgeon will use live action X-ray, known as fluoroscopy, throughout the procedure to locate your diseased vertebral segments and precisely guide the instruments. Appropriate surgical markings will be made on your back. Your surgeon will then introduce metal tubes through tiny skin incisions directly over the pedicles without retracting the muscles off the vertebral bones. This allows for less damage to the back muscles. Puncture holes will then be made through the metal tubes onto the pedicles and pedicle screws are inserted into the respective pedicles. The screws act as firm anchor points and your surgeon will then tunnel a rod through the screws. The rod connects the screws and prevents motion of the vertebral segments resulting in a stable spine fixation.

Post-Operative Care

  • Depending on your type of surgery, you may need to wear a back brace.
  • It takes about 3 months for your fusion to set and you should avoid activities which require heavy bending, lifting, or twisting of your spine during this period.
  • Avoid vigorous activities such as running and other sports.
  • Your doctor will recommend a good exercise program to strengthen your spine and back muscles.
  • You may resume your normal activities 3 months after your surgery.

Advantages

Minimally invasive pedicle screw instrumentation has the following advantages over traditional open surgery:

  • Minimally invasive procedure requiring less surgical time, and reduced time under anesthesia.
  • Less pain, scarring and blood loss as the procedure causes less damage to the adjacent tissues.
  • Early recovery and faster return to normal activities.

Risks and complications

Minimally invasive pedicle screw instrumentation is a relatively safe procedure and complications occur infrequently. Some of the potential complications include:

  • Breakage of the rod and screw
  • Loosening or loss of correction
  • Damage to the adjacent nerve roots
  • Infection
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Dr. Josue P. Gabriel frequently gives lectures for the benefit of furthering scientific research and medical education.