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Abstract
Percutaneous fixation of the lumbar spine was first described by Magerl, (1982) who used an external fixator. Mathews, Long, (1995) first described and performed a wholly percutaneous lumbar pedicle fixation technique in which they used plates as the longitudinal connectors. Lowery, Kulkarni, (2000) subsequently described a similar technique in which rods were placed. Although the latter authors reported high success rate, Mathews, Long noted a significant rate of nonunion. In all cases, the longitudinal connectors were placed either externally or superficially, just beneath the skin. This has several potential disadvantages. First, the superficial hardware can be irritating and requires routine removal. Second, longer screws (and thus longer moment arms) are required, producing a less effective biomechanical stabilization than that achieved using standard pedicle fixation systems and leading to a higher potential for implant failure.
The use of the percutaneous technique with or without virtual fluoroscopy offers several distinct advantages over conventional pedicle screw fixation. The system eliminates the need for a large midline incision and significant paraspinous muscle dissection. Both the pedicle screws and the precontoured rod are placed through stab incisions.