Purpose Lumbar fusion using lateral single position surgery (LSPS) gained popularity
during the last few years. While prone percutaneous pedicle screw placement is well
described, placing percutaneous pedicle screws with the patient in the lateral position
is considered the most complicated part of LSPS. In this article we describe the fluoroscopy
navigated technique for lateral percutaneous screw placement using the tunnel view
technique. Methods The radiologic background and principles of the tunnel view technique
are described. In addition, the special positioning of the patient, the C-arm and
the surgical technique is discussed in detail. Results This technique is used as the
standard for percutaneous screw placement in the prone or lateral positions in our
department since 2017. Since the introduction of this technique we have had 0% reoperation
rate for symptomatic malpositioned pedicle screws. Conclusion The tunnel view technique
simplifies pedicle screw placement while allowing for permanent observation of pedicle
walls and the superior joint surface during placement of the Jamshidi needle. It also
allows for confirmation of intrapedicular position of the screw after its implantation.
This technique is safe and feasible in our clinical experience.
