A less-invasive technique for posterior spinal fusion using intermittent retraction during pedicle screw insertion: A technical note

Abstract

Objectives: Preserving muscle function and integrity during and after posterior lumbar surgical intervention is a cornerstone for good surgical results. Prolonged application of fixed retractors results in ischemic changes of the paraspinal muscles, postoperative persistent back pain, and muscle dysfunction. Fixed retractors may alter the projection of pedicle screw insertion resulting in breaching the pedicle wall and misdirected screws. We describe a new technique for muscle retraction using intermittent during pedicle screw insertion. Methods: We use a less-invasive technique for pedicle screw insertion through a midline 3 cm skin incision per level and traditional appendectomy “Langenbeck” retractors for paraspinal muscle intermittent retraction during pedicle screw insertion. Results: Despite the small incision, our technique allows freedom to direct the screw trajectory and lessens the need for a fixed retractor except during the discectomy. Blood transfusion is applied only for patients with medical co-morbidity such as anemia or impaired coagulation. Post operative analgesia included paracetamol and non steroidal injection if required with smooth wound healing. Patients, recovery is usually uneventful with improvement of their complains. Conclusion: This technique combines the benefits of both traditional and minimally invasive surgery and is a useful advance in the field of posterior lumbar surgery and pedicle screw insertion.

Keywords

• Less invasive
• Intermittent
• Retraction
• Pedicle screw
• Lumbar fusion