Percutaneous pedicle screw fixation may be indicated for multiple scenarios, such as Trauma, Degenerative, Tumor, and Deformity. The pre- and postoperative care vary for each pathology.
Based on preoperative exams, such as X-Ray, CT, and MRI, the preoperative plan should include the following:
Adequate analysis of overall coronal and sagittal spinal alignment may be indicated for planning
Size, diameter, optimal positioning, and location of implants
Number of levels to be included in the fusion
Evaluation of necessity of associated spinal cord decompression
Combined procedures, such as osteotomies or interbody fusion, and their approach – posterior, lateral, or anterior.
Verify the site with the patient along with the type of operation planned
Ensure that the surgeon has marked the operative site
Condition of the skin and soft tissues on the areas that will be incised and also load regions based on the patient’s decubitus during the procedure
Check comorbidities, medications, and allergies for personalized adjustments
Details of the patient, including a signed consent form, appropriate antibiotic prophylaxis, and thromboprophylaxis following institution guidelines.
Commonly, the procedure is done under general anesthesia with endotracheal intubation
Avoid hypotensive anesthesia (the goal is to keep mean arterial blood pressure > 80mmHg) in patients with spinal cord injury.
Antibiotics are administered according to local antibiotic policy and specific patient requirements.
Cephalosporins with gram-positive coverage is generally recommended; however, local bacterial resistance profile and patient characteristics must be considered.
The administration is before the surgery, at specific time intervals, and also based on blood loss estimative.