Spine Surgery and Related Research
Online ISSN : 2432-261X
ISSN-L : 2432-261X
Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide
Tomoaki KoakutsuToshimi AizawaEiji Itoi
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2020 Volume 4 Issue 4 Pages 358-364


Introduction: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system.

Technical Note: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion.

Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately.

Conclusions: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments.

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© 2020 The Japanese Society for Spine Surgery and Related Research.

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