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Feasibility Of Endoscopic Inspection Of Pedicle Wall Integrity In A Live Surgery Model

Kristen Radcliff, MD,1 Harvey Smith, MD,2 Bobby Kalantar, MD,3 Robert Isaacs, MD,4 Barrett Woods, MD,1 Alexander R. Vaccaro, MD, PhD, MBA,1 James Brannon, MD5

1Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 2Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, 3Department of Orthopedic Surgery, Georgetown University, Washington, DC 4Department of Neurological Surgery, Duke University, Durham, NC 5Orthopedic Sciences, Inc, Seal Beach, CA

Abstract

Introduction

Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches.

Methods

A live porcine model was used. Eight lumbar pedicles were cannulated. Clinically significant breaches were created. An endoscope was introduced and was used to inspect the pedicles.

Results

All lumbar pedicles were endoscopically visible at a systolic pressure of 100 mm Hg. Clinically relevant anatomic structures and iatrogenic pathology, such as medial, lateral, and anterior breaches, were identified. There were no untoward events resulting from endoscopic inspection of the pedicle endosteal canal.

Discussion

Endoscopic inspection of lumbar pedicles was safe and effective. The findings on endoscopic inspection corresponded with the ball-tip probe palpation techniques. Additional techniques, such as selection between two tracts, was possible with the endoscopic technique.

keywords: 
Endoscopic Spine Surgery, Endoscopy, Intraosseous endoscopy, spine fusion, Spine Instrumentation, pedicle screws, Pedicle cannulation, minimally invasive spine surgery
Volume 10 Proof 30
doi: 
10.14444/proof30