Safety and Efficacy of Percutaneous Pedicle Screw Placement Using a Power Tool


Atsushi Kojima1)3), Atsushi Fujii2), Shigeta Morioka2), Yoshiaki Torii2), Kenichiro Arai3), Yutaka Sasao4)

1) Spine Center, Funabashi Orthopaedic Hospital, Chiba, Japan
2) Department of Orthopaedic Surgery, St. Marianna University, School of Medicine, Kanagawa, Japan
3) Department of Orthopaedic Surgery, Saint Joseph's Hospital, Kanagawa, Japan
4) Department of Orthopaedic Surgery, International University of Health and Welfare Shioya Hospital, Tochigi, Japan


Introduction: This study compared traditional manual methods and power tool use with regard to the speed and accuracy of percutaneous pedicle screw (PPS) placement and determined the advantages associated with the use of power tools.
Although the indication of PPS placement in minimally invasive spine stabilization (MISt) procedures has been recently expanded, there are no reports on PPS insertion using a power tool.
Methods: We evaluated 35 patients who underwent PPS insertion using a power tool during MISt procedures. On one side, PPS insertion was performed using the manual (M) method, whereas on the contralateral side, insertion was performed using the power tool (P) method. We assessed the number of implanted PPSs, time taken to implant PPSs after guidewire insertion, and accuracy of PPS placement as ranked postoperatively using computed tomography images.
Results: A total of 294 PPSs were inserted (147 using the M method and 147 using the P method). The mean PPS insertion time was 10.5 s using the P method and 27.4 s using the M method. The time required for inserting a screw using the P method remained consistent in the range of 10-15 s, whereas the time using the M method tended to increase from the second screw onward, with a range of 25-30 s. With regard to PPS insertion accuracy, a 2 mm or more pedicle breach was noted in 2 (1.4%) case after the P method and in 2 (1.4%) case after the M method.
Conclusions: PPS placement using power tools has the potential to save the surgical time during MISt procedures.

Released: January 27, 2018; doi: