Accuracy of percutaneous pedicle screw insertion technique with conventional dual fluoroscopy units and a retrospective comparative study based on surgeon experience

Masayuki Nakahara, Takao Yasuhara, Takafumi Inoue, Yuichi Takahashi, Shinji Kumamoto, Yasukazu Hijikata, Akira Kusumegi, Yushi Sakamoto, Koichi Ogawa, Kenki Nishida

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7 Citations (Scopus)


Study Design Retrospective comparative study Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: < 2 mm; grade III: ≤ 2 to < 4 mm). Results Of 658 PPSs, only 21 screws weremisplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in grade III misplacement had a transient symptom of leg numbness. Median radiation exposure time during PPS insertion was 25 seconds and 51 seconds, respectively (p < 0.01). Conclusions Without using an expensive imaging support system, the classic technique of PPS insertion using dual fluoroscopy units in the lumbar and sacral spine is fairly accurate and provides good clinical outcomes, even among surgeons lacking experience.

Original languageEnglish
Pages (from-to)322-328
Number of pages7
JournalGlobal Spine Journal
Issue number4
Publication statusPublished - Jul 1 2016
Externally publishedYes



  • Accuracy
  • Dual fluoroscopy units
  • Percutaneous pedicle screw
  • Radiation exposure
  • Surgeon experience

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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