Percutaneous Transpedicular Screw Insertion Technique ( Sextant )

Boucher was the first to use screws that crossed through the strongest point of attachment of the facet joint into the pedicle and the body of the vertebra below. He declared a pseudorthrosis rate of 14% to 17% including multilevel fusions (1). The use of pedicle screw–assisted spinal stabilization has become increasingly popular worldwide. Pedicle screw systems engage all three columns of the spine and can resist motion in all planes. Analysis of several studies suggests that pedicle screw fixation is a safe and effective treatment for many spinal disorders (2,3). The pedicle screw-bone junction provides the strongest point of attachement of the instrument to the spine. Thus, pedicle screw fixation systems can resist motion in all planes (1). Pedicle screws have dramatically improved the outcomes of spinal reconstruction requiring spinal fusion. Short-segment surgical treatments based on the use of pedicle screws for the treatment of neoplastic, developmental, congenital, traumatic, and degenerative conditions have been proved to be practical, safe, and effective (4). The funnel technique provides a straightforward, direct, and inexpensive way to very safely apply pedicle screws in the cervical, thoracic, or lumbar spine. Carefully applied pedicle-screw fixation does not produce severe or frequent complications. Pedicle screw fixation can be effectively and safely used wherever a vertebral pedicle can accommodate a pedicle screw-that is, in the cervical, thoracic, or lumbar spine. Pedicle-screw fixation represents the so-called gold standard of spinal internal fixation (4). Pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. It provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation (5). The stiffness of the pedicle fixation allows for the incorporation of fewer normal motion segments to achieve stabilization of an abnormal level. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown (5).