Open Versus Endoscopic Lumbar Pedicle Screw Fixation

Introduction:

With improved spinal instrumentation and surgical technique, the non-union rate for spinal fusion has dramatically declined in recent years. However, pseudoarthrosis remains common in certain patient populations such as the elderly, those who smoke and drink, those with metastatic and metabolic disorders, and those who do not comply with post-operative recommendations. In these populations and others, the non-union rate can be as high as 35% (1). In addition to non-union, complications associated with the harvest of autogenous bone such as donor site morbidity, blood loss, and increased operative time, has prompted the search for suitable alternatives (2,3). In addition to these problems, many spinal fusion surgeries are lengthy procedures that involve a relatively large surgical field, and are associated with a great deal of morbidity and a long hospital stay.

Recently, many new bone graft substitutes are being designed to incorporate or mimic one or more of the bone-forming components of autogenous bone to prevent the morbidity of the bone graft donor site. This is often achieved by combining a purified, recombinant form of an osteoinductive protein with an osteoconductive