What is 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.
Who are candidates for the lumbar pedicle screw system?
The use of pedicle screws in lumbar fusion procedures has improved spinal fusion success rates from 60% to 90%. This makes the use of these screws and rods valuable for a variety of patients who have spinal instability, in addition to damaged discs that have allowed the nerves in the area to become compressed. These are all conditions where Dr. Lipani could opt to use pedicle screws and rods to achieve greater stability:
- Patients with existing painful spinal instability, such as caused by post-laminectomy spondylolisthesis
- Patients with potential instability due to spinal stenosis or degenerative scoliosis
- Patients with degenerative disc disease
- Patients who have undergone multiple micro discectomies or decompression surgeries
- Patients with unstable fractures
How is Lumbar Fusion Surgery Performed?
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.
What are the Risks of Pedicle Screws During a Spinal Fusion?
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.
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.
Is lumbar fusion surgery using pedicle screw fixation painful?
As mentioned above, due to the small incisions and minimally invasive aspects of these surgeries at Princeton Neurological Surgery, recovery is far easier and less painful than when using traditional methods. Because Dr. Lipani doesn’t have to make large open incisions to gain access to the spine and to place the pedicle screws and rods, there is much less pain involved in your recovery.
Is surgery using the lumbar pedicle screw system safe?
Pedicle screws were first used in 1959, but all the way up into the 1980s there was a fairly high risk, approximately 10%, of breakage of either the pedicle screws or the connecting rods. That has since changed with modern materials and manufacturing methods. Today, the screw breakage rate is about 1 in 1,000.
Affixing pedicle screws is standard in lumbar fusion surgeries. By using the CD Horizon Sextant system, Dr. Lipani can achieve the same ends with much less recovery time. There is a risk of infection and nerve damage, but the minimal incisions created with this procedure make those risks rare. Dr. Lipani’s extensive training and expertise as a board-certified neurological surgeon further lowers risks involved. He also has extensive specific training with the CD Horizon Sextant system, and this separates his expertise even further from most other surgeons.
Also, when considering the risks involved with spinal fusion, patients do need to weigh the impact and risks to their lives of not addressing the nerve compression, chronic pain, and spinal instability. Those risks to the patient’s health are actually far greater than those presented by this procedure.
What is the recovery from surgery when using the pedicle screw fixation system?
Because the use of pedicle screws and rods provides instant stability to the section of fused vertebrae, this allows immediate mobility for the patient, and then makes for an easier and faster recovery.
Because Dr. Lipani uses the CD Horizon Sextant system of lumbar pedicle screw fixation, this makes recovery even easier. Why? Dr. Lipani places the pedicle screws through a series of tiny incisions using fluoroscopic x-ray imaging to provide accurate guidance. The CD Horizon Sextant system also allows for placement of the rods through the heads of the screws using the same small incisions.
This alleviates the need for larger open incisions, which have been necessary with traditional methods of pedicle screw fixation. In traditional methods, the muscles would be stripped away from the spine and detached in order to access the bones of the spine. With the CD Horizon Sextant system, Dr. Lipani can avoid that.
Patient recovery varies, but these recoveries are generally much quicker and involve far less pain because the patient has instant stability and doesn’t have to deal with the healing of cut muscles and large incisions.
Read what our patients are saying!
" I began to experience pain that started in my lower back and traveled down the back of my leg to my knee. It was constant and excruciating and seemed to be more intense each day. The pain pills were no longer helping. An MRI showed a spinal tumor in my lower back wrapped around a nerve. My doctor said it looked benign but would require a specialist to safely remove it from my nerve. He referred me to see Dr. Lipani. Dr. Lipani explained my problem and how he proposed to fix it. Admittedly, I was apprehensive at first. After all, spinal surgery was not something I ever wanted to experience. However, during a thorough discussion Dr. Lipani explained how he was going to use the latest surgical techniques along with the latest technology to keep me safe. I was reassured and felt much more at ease going into surgery. I am happy to report that it was a success! My tumor was removed and I was back to work the following week. I was extremely lucky to find Dr. Lipani. Dr. Lipani is an amazing surgeon and I will always be grateful to him for helping me get through such a difficult time in my life. "
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Is surgery with the lumbar pedicle screw system covered by insurance?
These procedures are important for the patient’s immediate health and for his or her long-term quality of life. The chronic pain and possible permanent nerve damage due to compression make these necessary procedures. They are covered by insurance.