{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T20:51:16Z","timestamp":1792356676392,"version":"4.4.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Over the past decade percutaneous pedicle screws have become popular for the minimally invasive treatment of spinal disorders. However, until the last 5 years the presence of a significant spinal deformity was regarded as a relative contraindication for percutaneous instrumentation. Recent advances in surgical technique and intraoperative technology have made percutaneous fixation in complex spinal pathologies more commonplace. The authors report their experience using a parsimonious method for uniplanar fluoroscopic targeting of pedicles in challenging cases.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed a retrospective analysis of patients with adult spinal deformity who underwent percutaneous pedicle screw instrumentation from 2008 to 2013. Cases were included if a spiral slice postoperative CT scan was obtained. All cases had a minimum of 10\u00b0 of axial rotation and typically had additional accompanying anatomical abnormalities. Screws were assessed for any pedicle violations as well as any impingement of the surrounding facet joints.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 410 pedicle screws were placed in 36 patients with an average 6.4 levels of instrumentation per patient. The mean age was 67 years (range 44\u201386 years) and there were 25 females. Of the 410 screws, 29 (7.1%) had some medial or lateral pedicle violation. Of these, 15 (3.7%) were Grade 1, 6 (1.4%) were Grade 2, and 8 (2.0%) were Grade 3 violations. Of the Grade 3 violations, 2 each were at the L-4, L-5, and S-1 levels, and 1 each was at the T-10 and L-1 levels. Two of the patients had symptoms and both underwent screw repositioning, one during the same admission and the other in a delayed fashion. Both were at the L-5 and S-1 levels with anatomically highly medialized pedicles. There were no motor deficits, and both removals were for numbness. Of the 72 screws at the proximal end of the construct, there were 6 facet violations (8.3%). Four (5.6%) of these were Grade 1, 1 (1.4%) was Grade 2, and 1 (1.4%) was Grade 3.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The anteroposterior fluoroscopic technique can be effectively used by spinal surgeons to cannulate the pedicles in patients with rotational deformities. The complication rate in this challenging population is acceptable and is in accordance with the existing literature. However, caution should be used at L-5 and S-1 when the pedicle is narrow and highly medialized, rendering an indistinct medial wall on anteroposterior imaging.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.7.spine13846","type":"journal-article","created":{"date-parts":[[2014,8,29]],"date-time":"2014-08-29T14:07:26Z","timestamp":1409321246000},"page":"826-832","source":"Crossref","is-referenced-by-count":21,"title":["Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation"],"prefix":"10.3171","volume":"21","author":[{"given":"Faiz U.","family":"Ahmad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine13846","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"716.e1","DOI":"10.1016\/j.wneu.2011.12.092","article-title":"Percutaneous trans-facet screws for supplemental posterior cervical fixation","volume":"78","author":"Ahmad","year":"2012"},{"key":"b2-spine13846","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1227\/NEU.0b013e31826a88c8","article-title":"Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement","volume":"71","author":"Babu","year":"2012"},{"key":"b3-spine13846","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1097\/00007632-199606010-00008","article-title":"Accuracy of pedicle screw placement in lumbar vertebrae","volume":"21","author":"Castro","year":"1996"},{"key":"b4-spine13846","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1007\/s00586-008-0776-9","article-title":"Technical factors related to the incidence of adjacent superior segment facet joint violation after transpedicular instrumentation in the lumbar spine","volume":"17","author":"Chen","year":"2008"},{"key":"b5-spine13846","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s00586-012-2476-8","article-title":"Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial","volume":"22","author":"Heintel","year":"2013"},{"key":"b6-spine13846","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"593","DOI":"10.3171\/2013.3.SPINE12829","article-title":"Superior articulating facet violation: percutaneous versus open techniques. 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