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Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 57-61

Direct visualization of a S1 medial pedicle breach using a novel endoscope: A case report with new endoscopic pedicle breach classification

Anterior Spine Institute for Research and Education, Denver; Skyridge Medical Center, Lone Tree, CO, USA

Correspondence Address:
Dr. Michael Gallizzi
Anterior Spine Institute for Research and Education, 660 Dexter Street, Denver, CO 80220; Skyridge Medical Center, Lone Tree, CO
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DORJ.DORJ_13_20

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Malpositioned pedicle screws can lead to motor and sensory deficits in the effected level. Traditional intraoperative techniques to avoid a malpositioned pedicle screw include manual palpation of the screw tract, intraoperative imaging (XR, Fluro, and computed tomography), and neuromonitoring. This case report discusses an arthroscopic application of a novel endoscopic camera. This new direct visualization technique answers the intraoperative question of a pedicle screw breach. A 57-year-old male presented to our outpatient clinic for continued left S1 radiculopathy after multiple previous spinal surgeries. His presenting construct was a L4-S1 pedicle screw instrumented posterior spinal fusion with an anterior lumbar interbody fusion interbody at L5-S1 and a TLIF at L4-5 with complete laminectomies of L4-S1. He had failed >12 months of nonoperative treatment for his continued left S1 radiculopathy. He underwent a left S1 hardware removal with arthroscopic intra peculiar evaluation and decompression. Informed consent was obtained from the patient before writing this case report. At 3 months postoperation, the patient demonstrated full resolution of his left S1 radiculopathy, and his strength was rehabilitated back to 5/5. His paresthesia remained in the left S1 dermatome. This case report adds an off-the-shelf intraoperative technique for directly visualizing a pedicle screw breach, evaluating the continuity of the affected nerve, and gives the option to decompress bony fragments which may be a source of continued pain if not removed. The purposed endoscopic breach classification system allows for future studies to give prognostic information about nerve recovery potential based on the amount of breach encountered endoscopically.

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