Lumbar Pedicle Screw Fixation
Pedicle screw systems are an important method of achieving spinal stabilization in certain patients during spinal fusion procedures. Spinal fusion surgery using instrumentation devices such as pedicle screws has become increasingly common as advances have been made in both the techniques available and our knowledge of the biomechanics of the spine. Often the best option to treat spinal instability, spinal fusion is usually done in conjunction with other procedures that require the removal of bone, which can leave the area weak and unsupported. The instrumentation refers to metal implants of screws and rods that are designed to improve alignment between the vertebrae and help ensure that fusion occurs. They provide strength and stability to the affected area of the spine.
The procedure is performed to join (fuse) the vertebrae together in patients with conditions such as spinal stenosis, degenerative disc disease or spondylolisthesis. Spinal fusion may be done anywhere on the spine, depending on which vertebrae are affected, but lumbar procedures concentrate on the lower portion of the spine. During fusion surgery, bone growth is stimulated and then used to link the vertebrae together to stop the painful movement in the area. During the procedure, the disc between the affected vertebrae is removed, and a bone graft is inserted into the empty space. Titanium metal screws and rods are frequently used to hold the bones in position, provide stability and bridge any remaining open areas once bone or disc material has been removed.
The use of pedicle screws in spinal fusion surgery has greatly improved the success rate of these procedures. Stability is achieved right away and this allows for immediate mobility, enabling an easier and quicker healing process.
Pedicle Screw Fixation with the CD Horizon Sextant System
Using the CD Horizon Sextant System from Medtronic for pedicle screw fixation offers all of the stability of older methods of instrumentation without injury or potential damage to nearby tissue and muscles. This allows spinal fusion to be performed in a minimally invasive manner, resulting in less time in the hospital, a more comfortable and shorter recovery period and smaller, easier to conceal scars.
Specialized surgical tools are used for the implantation of the pedicle screws and rods. With the help of a fluoroscope to provide real-time X-ray imaging of the spine, Dr. Lipani will make tiny incisions in the skin in the area that requires the screws. Dilator tubes are slowly inserted to gently separate the muscle tissue where it naturally divides, providing the surgeon with access to the lumbar spine.
Screw extender devices are used to precisely place the screws once a rod insertion device is attached. The tools act in concert to insert the rod through the heads of each perfectly aligned screw. Once the screws and rods are firmly affixed in the vertebrae, Dr. Lipani will remove the devices. Since the muscle tissue is not cut, it simply resumes its natural positioning. Dr. Lipani then sutures closed the skin incisions.
This system represents important progress from the traditional methods of pedicle screw fixation. Previously, an open approach was required, necessitating several large incisions on the back. The muscles would be stripped away from the spine and detached in order to reach the bones of the spine.
Pedicle screws are rarely removed after spinal fusion surgery. Even once the bone graft has expanded and can provide stability on its own, it is safer to leave them in place rather than undergo a procedure to remove them. The only exception is for those few patients who are experiencing considerable discomfort.
Pedicle Screw Risks
Affixing pedicle screws during a spinal fusion procedure is a standard element of the surgery and is considered very safe when performed by an experienced surgeon. Complications are rare, but those associated with the use of pedicle screws include screw or rod breakage, infection and nerve damage.