Utility of Power Tool and Intraoperative Neuromonitoring for Percutaneous Pedicle Screw Placement in Single Position Surgery: A Technical Note.

Objective This study aimed to demonstrate the utility of power tools and intraoperative neuromonitoring of percutaneous pedicle screw (PPS) insertion (so-called PPS monitoring) by SINGLE-position surgery (SPS) after lateral lumbar interbody fusion. Methods A retrospective analysis of medical records from a single center was performed to identify patients who underwent SPS for lateral lumbar interbody fusion and posterior fixation using PPS during intraoperative computed tomography navigation from 2020 to 2021. We investigated the PPS insertion time and screw positional accuracy of patients who underwent SPS involving power tools and PPS monitoring during this period. In this technical note, we report on this surgical technique. Results Twenty-four patients (mean age 72.0 ± 8.5 years, range 53–81 years) were included in this study. There were no intraoperative complications in all cases. Posterior fixation using PPS was added in all cases, and a total of 106 PPSs were inserted. It took an average of 6.2 ± 2.4 seconds to insert the PPS from the PPS insertion point to the end using a power tool and PPS monitoring. Moreover, there were no cases of pedicle breaches. Conclusions Similar to previous reports related to power tools in the prone position, the lateral decubitus SPS technique can also use power tools to save PPS insertion time. Furthermore, we suggest that the use of PPS monitoring may prevent erroneous PPS insertions by using intraoperative computed tomography navigation in advance.