Percutaneous transdiscal pedicle screw fixation for osteoporotic vertebral fracture: A technical note

Abstract Background Pedicle screw fixation is the standard method for stabilizing fractures in an ankylosed spine, as seen in diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis. However, with the conventional screw insertion technique, screw loosening, backout and loss of fixation are often encountered in osteoporotic bone. To enhance screw pull-out strength, we describe a new technique of percutaneous transdiscal pedicle screw (TPS) insertion in this technical note. Methods A 74-year-old man with DISH presented with severe back pain and impending paraplegia secondary to osteoporotic T11 vertebral fracture. We performed short-segment PTS fixation under computer navigation guidance. Screws were inserted in a 25° cephalad direction to engage the superior endplate of the instrumented vertebrae. Increased insertional torque was appreciated by the surgeon when the screw engaged the superior endplate, but was not felt while crossing the pedicle. Results Computed tomography (CT) immediately postoperatively showed the screws in the intended position engaging the superior end plate. On 1-year follow-up, the patient was asymptomatic, with the fracture healed and no implant loosening. Conclusions The PTS insertion technique may be a useful option for spine fixation in DISH to overcome the problems of osteoporotic bone by enhancing screw pull-out strength.