From the Research
The proper technique for pedicle screw insertion involves placing the screw at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process, as this method has been shown to be viable and have a higher success rate and shorter operation time 1.
Key Steps in Pedicle Screw Insertion
- Preoperative planning using imaging studies to determine screw trajectory and size
- Identification of anatomical landmarks and creation of an entry point at the junction of the transverse process and lateral facet
- Use of a pedicle probe to create a pilot hole, followed by palpation with a ball-tipped probe to ensure the pedicle walls remain intact
- Tapping of the hole to the appropriate depth before inserting the screw
- Use of intraoperative fluoroscopy or navigation systems to confirm proper placement ### Important Considerations
- Typical screw sizes range from 4.5-7.5mm in diameter and 30-55mm in length, depending on the spinal level and patient anatomy
- Potential complications include pedicle breach, nerve root injury, and vascular damage, making meticulous technique essential
- Thorough knowledge of spinal anatomy is required, as the pedicle serves as a strong anchor point connecting the anterior and posterior elements of the vertebra, providing excellent three-column fixation for spinal fusion procedures ### Additional Tips and Tricks
- Use of a single or double intraoperative fluoroscopy to ensure safe implantation of pedicle screws 2
- Consideration of fixation in osteoporotic patients, percutaneous insertion of long rods, compression/distraction using multiaxial screws turning into monoaxial, and use of minimally invasive retractor for interbody fusion 2
- Implementation of 20 tips to avoid and handle problems in the placement of percutaneous pedicle screws, as outlined in a study by spinal surgeons at different minimally invasive spine surgery reference centers 3