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J Neurol Surg A Cent Eur Neurosurg 2025; 86(01): 038-047
DOI: 10.1055/s-0043-1777751
Original Article

Stand-Alone Percutaneous Pedicle Screw Lumbar Fixation to Indirectly Decompress the Neural Elements in Spinal Stenosis: A Radiographic Assessment Case Series

Roberto Gazzeri 
1   Department of Neurosurgeon - Pain Therapy, San Giovanni-Addolorata Hospital, Roma, Lazio, Italy
,
Konstantinos Panagiotopoulos
2   Department of Neurosurgery, San Giovanni-Addolorata Hospital, Roma, Lazio, Italy
,
Marcelo Galarza
3   Department of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain
,
Matteo Luigi Giuseppe Leoni
4   Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Emilia-Romagna, Italy
,
Umberto Agrillo
2   Department of Neurosurgery, San Giovanni-Addolorata Hospital, Roma, Lazio, Italy
› Author Affiliations Funding None.
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Abstract

Background The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies.

Methods Twenty-eight patients presenting with spinal degenerative diseases including concomitant central and/or lateral stenosis were treated with stand-alone percutaneous pedicle screw fixation. Radiographic measurements were made on axial and sagittal magnetic resonance (MR) images, performed before surgery and after a mean follow-up period of 25.2 months. Measurements included spinal canal and foraminal areas, and anteroposterior canal diameter.

Results Percutaneous screw fixation was performed in 35 spinal levels. Measurements on the follow-up MR images showed statistically significant increase in the cross-sectional area of the spinal canal and the neural foramen, from a mean of 88.22 and 61.05 mm2 preoperatively to 141.52 and 92.18 mm2 at final follow-up, respectively. The sagittal central canal diameter increased from a mean of 4.9 to 9.1 mm at final follow-up. Visual analog scale (VAS) pain score and Oswestry Disability Index (ODI) both improved significantly after surgery (p < 0.0001).

Conclusion Stand-alone percutaneous pedicle screw fixation is a safe and effective technique for indirect decompression of the spinal canal and neural foramina in lumbar degenerative diseases. This minimally invasive technique may provide the necessary decompression in cases of common degenerative lumbar disorders with ligamentous stenosis.

Keywords

neurogenic claudication - degenerative lumbar spine - decompression - MRI - percutaneous fixation - spinal fixation - minimally invasive spinal approach - foraminal area - spinal canal

Author Contributions

Study conception and design were done by R.G. and U.A. Data collection was done by R.G. and K.P. Analysis and interpretation of results were done by M.G. and M.L.G.L. All the authors reviewed the results and approved the final version of the manuscript.




Publication History

Received: 26 April 2023

Accepted: 06 November 2023

Article published online:
19 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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