MINIMALLY INVASIVE LUMBAR ARTHRODESIS AND PERCUTANEOUS PEDICLE SCREWS: A SYSTEMATIC REVIEW

BENITES, VINICIUS DE MELDAU; SPARAPANI, FABIO VEIGA DE CASTRO; IUNES, EDUARDO AUGUSTO; ONISHI, FRANZ JOOJI; SALATI, THIAGO; CAVALHEIRO, SERGIO; PAZ, DANIEL DE ARAÚJO

doi:10.1590/S1808-185120201904228299

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ORIGINAL ARTICLE • Coluna/Columna 19 (4) • Oct-Dec 2020 • https://doi.org/10.1590/S1808-185120201904228299 copy

MINIMALLY INVASIVE LUMBAR ARTHRODESIS AND PERCUTANEOUS PEDICLE SCREWS: A SYSTEMATIC REVIEW

ARTRODESE LOMBAR MINIMAMENTE INVASIVA E PARAFUSOS PEDICULARES PERCUTÂNEOS: REVISÃO SISTEMÁTICA

ARTRODESIS LUMBAR MÍNIMAMENTE INVASIVA Y TORNILLOS PEDICULARES PERCUTÁNEOS: REVISIÓN SISTEMÁTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

A systematic review of the literature was performed in order to organize, evaluate, and select evidences available about the safety and efficacy of minimally invasive percutaneous arthrodesis with percutaneous pedicle screws in the treatment of patients with degenerative disc disease (and other spinal pathologies) as compared to conventional arthrodesis. PubMed, EMBASE and Cochrane Library databases were consulted to locate clinical trials and case reports/case series published in English between 2014 and 2019. After selection according to the inclusion/exclusion criteria, 21 of the 197 articles identified were chosen for a complete reading and used for the present review. Although the level of evidence of most of the studies included made the demonstration of efficacy and superiority among the surgical techniques reviewed difficult, the findings related to the minimally invasive procedure indicate a safe and reliable approach for the treatment of lumbar diseases. Level of evidence II; Systematic review of literature.

Arthrodesis; Case Reports; Clinical Trial; Pedicle Screws; Spine; Spinal Fusion

	Source	Level of evidence	# of participants and sex	Mean age (years)	Diagnosis	Intervention	Control Group	Instrumentation	Graft/Implant	Surgical Time (minutes)	Blood loss (ml)	Adverse events	Follow-up (months)
1	Chachan et al. (2019)¹⁷	4^c	3 (F)	62	1: Spondylolisthesis and stenosis; 2: Disc herniation; 3: Spondylolisthesis and retrolisthesis with disc protrusion	Microscopic anterior neural lumbar decompression with OLIF	N/A	Percutaneous pedicle screws	Cellular allograft	NR	NR	No	1: 6; 2: 3; 3: 6
2	Kim et al. (2018)¹⁸	1^a	37 (F) 41 (M)	40-80	Degenerative spinal disease with lumbar stenosis	Robot PLIF	Freehand PLIF	Pedicle screws	Subproducts of the local lamina and facet joint bone + DBM	Robot-PLIF: 220.1 ± 55.9; Freehand-PLIF: 189.8 ± 45.1	NR	Freehand-PLIF: violation by screw and irritation of the nerve root	12
3	Anand et al. (2017)¹⁹	4^c	1 (F)	66	Adult spinal deformity	Minimally invasive circumferential protocol	N/A	Percutaneous pedicle screws	Local bone graft, RhBMP-2 and DBM	NR	NR	Abdominal discomfort	24
4	Coe et al. (2016)²⁰	4^c	1 (F)	75	Spondylolisthesis, spinal stenosis, and collapse of the disc space	TLIF	N/A	Cage and pedicle screws	Allograft	NR	100	No	3
5	Maruo et al. (2016)²¹	4^c	1 (F)	61	Lumbar disc herniation	TLIF	N/A	PEEK cage and percutaneous pedicle screws	Autologous bone graft	NR	300	Hemothorax	0.46
6	Wang et al. (2016)²²	4^c	1 (F)	68	Lumbar tuberculosis	Antituberculosis drugs, minimally invasive debridement and XLIF	N/A	Percutaneous pedicle screws	Autologous bone graft	220	500	No	12
7	Dailey et al. (2015)²³	4^c	1 (F)	24	Idiopathic scoliosis	Minimally incisional posterior fusion	N/A	Pedicle screws	Implant	NR	NR	Pseudoarthrosis	6
8	Kim et al. (2015)²⁴	1^a	21 (F) 19 (M)	Rom-PLIF: 64.4 ± 11.9; Cop-PLIF: 64.7 ± 8.6	Degenerative listhesis, lytic listhesis, foraminal and central stenosis	Rom-PLIF	Cop-PLIF	Pedicle screws	NR	Rom-PLIF: 217.75 ± 33.9; Cop-PLIF: 195 ± 46.9	NR	NR	NR
9	Sarwahi et al. (2015)²⁵	4^c	2 (F)	12.2	Neuromuscular scoliosis	1 – Posterior spinal fusion; 2 – Spinal deformity correction surgery	N/A	Pedicle screws	Allograft and autograft mixed with vancomycin in powder form	1: 300; 2: 420	1: 600; 2: 800	NR	NR
10	Brodano et al. (2014)²⁶	4^c	1 (F)	18	Adolescent idiopathic scoliosis type 1AN (Lenke)	Corrective surgery by minimally invasive fusion	N/A	Posterior pedicle screws	Bone graft from facet joint osteotomy and homologous bank	180	550	NR	12
11	Tender (2014)²⁷	4^c	2 (M)	67	Spondylolisthesis	1: Lumbar fusion; 2: Autonomous lateral lumbar fusion	N/A	1: Cage and plate; 2: Cage	Allograft	1: 60; 2: 45	NR	1: Coronal fracture and collapse of cage in the vertebral body; 2: Coronal fracture and collapsed cage	1: > 18; 2: 12
12	Wang et al. (2014)²⁸	2^b	56 (F) 25 (M)	55,3	Lumbar canal stenosis, spondylolisthesis, or post-laminectomy instability	MIS-TLIF	Open TLIF	MIS-TLIF: PEEK cage and percutaneous pedicle screws; open TLIF: cage and pedicle screws	MIS-TLIF: Autologous bone graft; open TLIF: NR	MIS-TLIF: 127 ± 25; open TLIF: 168 ± 37	MIS-TLIF: 274 ± 99; open TLIF: 645 ± 163	MIS-TLIF: 2 cases of dural rupture. Both: one case of non-union	36,1
13	Ntourantonis et al. (2018)²⁹	4^c	1 (F)	76	Vertebral fracture from osteoporosis with invasion of the spinal canal	Less invasive corpectomy and 360⁰ fusion	N/A	Pedicle screws	NR	NR	Yes	Postoperative bleeding	0.23
14	Fomekong et al. (2018)³⁰	4^c	1 (M)	60	Spondylodiscoarthrosis	TLIF	N/A	Percutaneous pedicle screws	NR	NR	NR	Ureteral perforation	5
15	Agarwal et al. (2016)³¹	4^d	3 (F) 4 (M)	29	Thoracolumbar burst fracture	Fixation with percutaneous pedicle screws	N/A	Percutaneous pedicle screws	Graft of corticocancellous bone and DBM	NR	NR	Hemorrhage due to violation by the screw	25.7
16	Suratwala et al. (2016)³²	4^c	1 (F)	72	Kyphoscoliosis	DLIF	N/A	Percutaneous pedicle screws and rod fixation	NR	240	150	Acute renal infarction	12
17	Funao et al. (2016)³³	4^c	2 (M)	74	Lumbosacral spondylodiscitis	1: MIS; 2: MIS and anterior fusion	N/A	1: Pedicle screws + percutaneous S2AI screws; 2: percutaneous S2AI screws	1: NR; 2: iliac bone graft	1: 188; 2: 178	1: 26; 2: 171	NR	NR
	Source	Level of evidence	# of participants and sex	Mean age (years)	Diagnosis	Intervention	Control Group	Instrumentation	Graft/Implant	Surgical Time (minutes)	Blood loss (ml)	Adverse events	Follow-up (months)
18	Phan et al. (2015)³⁴	4^c	1 (M)	72	Isthmic spondylolisthesis	Autonomous ALIF	N/A	Percutaneous pedicle screws	ANCHOR-L Implant	NR	60	Fracture across the sacral promontory and listhesis	12
19	Wakita et al. (2015)³⁵	4^c	1 (M)	80	Severe kyphoscoliosis and gait disorder	OLIF	N/A	Cage and percutaneous pedicle screws	NR	300	378	Reduced muscle strength	3
20	Staub et al. (2015)³⁶	4^c	1 (M)	51	Achondroplastic dwarfism	Arthrodesis	N/A	Cage and pedicle screws	Lateral graft	NR	NR	No	0.69
21	Chin et al. (2015)³⁷	4^c	2 (F)	49.5	1: Herniated central nucleus pulposus with annular fissure and disc desiccation; Possible hemilaminectomy defect, herniated nucleus pulposus with severe stenosis, disc collapse, and terminal plate changes	1: Lumbar fusion with percutaneous pedicle screws; 2: Decompression and lumbar fusion with percutaneous pedicle screws (open procedure)	N/A	1: PEEK cage and percutaneous pedicle screws 2: Pedicles	NR	NR	NR	NR	1: NR; 2: 11

Source	Main conclusions
Kim et al. (2018)^a	Need for more extensive follow-up, considering that the outcomes did not differ between the groups
Kim et al. (2015)^a	Adequacy of the quality control for robot-assisted pedicle screw fixation
Wang et al. (2014)^a	MIS-TLIF is a safe and reliable procedure for the treatment of obese and overweight patients as compared to the open procedure.
Chachan et al. (2019)^b	Decompression combined with oblique lumbar fusion is feasible and safe.
Anand et al. (2017)^b	A protocol with various minimally invasive techniques can be safe and effective for adult spinal deformity.
Coe et al. (2016)^b	The use of a multiexpandible cage allows a less invasive approach with satisfactory short-term clinical results.
Maruo et al. (2016)^b	First report of hemothorax following MIS-TLIF caused by rod with trocar tip. Attention to the insertion of the rod is necessary at the thoracolumbar levels.
Wang et al. (2016)^b	Extreme lateral fusion with pedicle screw can be an effective treatment for lumbar tuberculosis in the elderly.
Dailey et al. (2015)^b	Attention to the possibility of caudal migration after rod fracture.
Sarwahi et al. (2015)^b	The minimally invasive approach seems to offer benefits to patients with neuromuscular scoliosis.
Brodano et al. (2014)^b	The minimally invasive approach for the treatment of adolescent idiopathic scoliosis demonstrates deformity correction and advantages, but long-term data is needed.
Tender (2014)^b	Attention to the caudal vertebral fracture as a potential complication following minimally invasive lumbar fusion.
Ntourantonis et al. (2018)^b	Attention must be paid to signs of postoperative bleeding and hematomas.
Fomekong et al. (2018)^b	Attention to ureteral injury, considering its serious consequences.
Suratwala et al. (2016)^b	In patients with atherosclerosis, the lateral approach to the anterior lumbar spine may induce occlusion of the renal artery and renal infarction.
Funao et al. (2016)^b	Improvement of the clinical outcomes and percutaneous rigid stabilization of the lumbosacral spine. More in-depth investigations are necessary.
Phan et al. (2015)^b	Fusion is critical to achieving good functional results in isthmic spondylolisthesis with neurological symptoms.
Wakita et al. (2015)^b	The use of minimally invasive OLIF demonstrated advantages for the treatment of degenerative kyphoscoliosis in a patient with Parkinson’s disease.
Staub et al. (2015)^b	Apparently safe approach for achondroplastic dwarfism.
Chin et al. (2015)^b	Highly successful placement of pedicle screws
Agarwal et al. (2016)^c	Fixation with percutaneous pedicle screws may provide lasting benefits, although more in-depth investigations are necessary.

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[1] Correspondence: Vinicius de Meldau Benites. Rua Napoleão de Barros, 715, sexto andar, Vila Clementino, São Paulo, SP, Brasil. vmbenites@hotmail.com