| Objective:The objective of this study was to investigate the feasibility of Tactile Technique,and its accuracy of lumbosacral percutaneous pedicle screw placement.Methods:The Tactile Technique,that is,when a Jamshedi needle firstly touch the target transverse process,slide up and down the needle to feel the edge of the transverse process.Then the needle move along the transverse process to the medial side,until the tactile sensation of the articular process appears.The Jamshedi needle is then docked on the bony surface at the junction of the lateral facet joint and transverse process,which is the entry point of pedicle screw.According to the preoperative CT observation of the pedicle angle,the angle of the needle is adjusted.With the guide of intraoperative fluoroscopic images,the needle gradually advance into the pedicle.80 patients were selected from the First Affiliated Hospital of Guangzhou Medical University,who were underwent lumbar and sacral(L1-S1)pedicle screw fixation from August 2012 to August 2016.Exclusion criteria: open surgery,revision surgery,severe osteoporosis,severe hypertrophy of facet joint or transverse process patients.All patients underwent CT scan at 1 week postoperatively.(1)According to the criterion by Raley DA,each screw was classified into four grades based on its position inside the pedicle and the breach of its medial/lateral wall: Grade 0,screw within cortex of pedicle;Grade 1,the breach less than 2mm;Grade 2,the breach greater than 2mm,without any neurological complication;Grade 3,breach with screw-related neurological complications.(2)According to the criterion by Ahmad FU,all the screws were divided into four grades: Grade 0,screw not contacting facet synovium or subchondral cortical bone;Grade 1,screw in lateral facet cortical bone but not involving the synovium;Grade 2,part of screw in the articulating surface less than 1 mm;and Grade 3,screw traveling inside the facet joint space itself.(3)Evaluate each pedicle screw's fluoroscopy exposure times,operation time,and surgical blood loss etc.Results:Of the 80 patients,334 percutaneous screws were placed.The pedicle violation of all screws is 12.9%.31 screws(9.3%)were Grade 1,9(2.7%)were Grade 2 and 3(0.9%)were Grade 3.There were 38 facet violations(11.4%).Most of these were Grade 1 violations 26(7.8%),6(1.8%)were Grade 2 violations,and 6(1.8%)were Grade 3 violations of facet joint.The location of the pedicle screw violation in each segment was mainly in the medial wall(medial 62.8% and lateral 37.2%).There were 3 patients with complications caused by screw misplaced.2 cases were cured after 3 months of conservative treatment,and no recurrence after 1 year.Another patient needed a revision to adjust the screw position.The average times of fluoroscopy exposure of each screw fixation is 4.40.Each pedicle screw averagely required 17.4 ± 6.2 minutes' operation time and loosed the amount of 12.8 ± 5.5 ml blood during the screw placement.Conclusion:Relying on the tactile sensation,the Tactile Technique can quickly find the entry point of percutaneous pedicle screw fixation.The operation becomes simpler,and do not need to rely on continuous fluoroscopy exposure,significantly reducing the number of exposure times,reducing the radiation injury and operation time.The accuracy of pedicle screw placement is acceptability good with less postoperative complications.The lateral entry point of this Technique can avoid to contact the facet joints,and the incidence of joint violations is low. |
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