A novel tube technique enables visualization of the anatomy of the facet joints and accurate placement of the Jamshidi needles with low radiation exposure: Technical note

Abstract

Background: Percutaneous pedicle screws(PPS) have been used for decades. The difficult part of PPS placement is locating the proper entry sites on the facet joints for the Jamshidi needles. The correct positioning is usually ensured by fluoroscopy, which exposes surgeons and patients to extensive radiation exposure.

Objective: To describe a novel retractor tube technique used in the placement of PPS, which enables visualization of the anatomy of the facet joints and enables accurate placement of the Jamshidi needles.

Methods: A newly designed 15-mm-diameter retractor tube was applied during the placement of Jamshidi needles in 21 operations using PPS to treat thoracolumbar fracture. The anatomy of the entry site could be clearly visualized, and a Kirschner wire was inserted 2 mm into each of the ideal entry sites. When all the Kirschner wires were placed, the annular tubes of the Jamshidi needles were placed along the Kirschner wires into the pedicles. Fluoroscopy was used to confirm the positions of the Jamshidi needles. The rest of the procedure was conducted in the traditional PPS placement technique.

Results: The entrance sites were successfully accessed through the retractor tube, with only one adjustment needed at most. Only one or two fluoroscopy images were taken during the placement of the Kirschner wires, and another image was taken after all the Jamshidi needles were placed. Fluoroscopy confirmed that the positioning of the PPS was good.

Conclusion: A retractor tube accurately exposes the entry points on the facet joints in PPS placement, and is technically easy to use.

Keywords: 15 mm tube; Entrance site of facet joints; Jamshidi needles; Percutaneous pedicle screws; Radiation exposure.