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  • 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.

  • Spinal cord monitoring may be indicated.