Ct-/x-ray-guided technique in posterior lumbar spine fusion

Abstract

Posterior lumbar fusion (PIF) is considered one of the choices to be considered when traumatic, degenerative, or neoplastic diseases occur, generating spine instability. During the last 5 years, because of dramatic improvement in CT-guided techniques using a percutaneous approach, as well as new materials adopted by industries, minimal invasive spine surgery (MISS) performing PIF procedures with soft tissues incision smaller than 10 mm only and fully CT-guided approach becomes a reality. The possibility to perform the procedure directly into the CT scan room, adopting the widespread C-arm + CT combination technique, increases optimal results significantly reducing general PIF drawbacks, as radiation exposure for the patient and physicians, incorrect screw position, time duration of the procedure, and possible complications. Recently, new percutaneous approaches have been proposed to perform direct posterior facet joint fixation (FF), using trans-facet screws (TFF), introduced through the articular facets, or intra-facet fusion (IFF), with intra-articular implants. Both systems have been proved to obtain biomechanical stability equivalent to conventional PIF on finite elements analysis and for this reason are more and more used in those patients with local microinstability responsible for chronic low back pain, unresponsive to the conventional facet joint radioablation.