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Zhang X, Zhang Y, Gu Z, Li G. Comparison of midline lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion for treatment of lumbar degeneration disease. Sci Rep 2024; 14:22154. [PMID: 39333680 PMCID: PMC11437147 DOI: 10.1038/s41598-024-73213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 09/16/2024] [Indexed: 09/29/2024] Open
Abstract
Midline lumbar interbody fusion (MIDLIF) and minimally invasive transforaminal interbody fusion (MIS-TLIF) are two minimally invasive lumbar fusion methods that have gained popularity in the past two decades. MIDLIF involves the use of cortical bone trajectory screws, whereas MIS-TLIF uses traditional pedicle screws. However, there is a significant lack of research directly examining the clinical efficacy of these two methods in treating single-segment lumbar degenerative diseases. Hence, the objective of our retrospective study is to assess and contrast the surgical and clinical results of MIDLIF and MIS-TLIF. The study population comprised 133 patients diagnosed with single-segment lumbar degenerative disease that received treatment using either MIDLIF (n = 65) or MIS-TLIF (n = 68) in our department from January 2017 to January 2019. The fusion rates for MIDLIF were consistently lower than MID-TLIF at all post-operative time periods of follow-up, however, the differences between the two groups were not statistically significant. The 1-year fusion rates were 81.5% (MIDLIF) and 83.8% (MIS-TLIF) (P = 0.728), and the 2-year fusion rates were 87.7% (MIDLIF) and 91.2% (MIS-TLIF) (P = 0.513). The final follow-up fusion rates were 93.8% (MIDLIF) and 95.6% (MIS-TLIF) (P = 0.653). MIDLIF had several advantages over MIS-TLIF, including a shorter operative time (135.2 ± 15.70 vs. 160.1 ± 17.2 min, P < 0.001), decreased intraoperative blood loss (147.9 ± 36.4 vs. 169.5 ± 24.7 mL, P < 0.001), and a shorter length of hospital stay (10.8 ± 3.1 vs. 12.4 ± 4.1d; P = 0.014). No significant differences were seen between the groups in terms of the postoperative day of ambulation, Oswestry dysfunction index (ODI) scores, and visual analog scale (VAS) scores for leg and lower back pain (P > 0.05). Although not significant (P = 0.707), MIDLIF (13.8%) had fewer overall complications than MIS-TLIF (16.2%). Therefore, compared to MIS-TLIF, MIDLIF provides perioperative benefits while achieving the same outcomes as MIS-TLIF in terms of fusion rate, pain relief, functional improvement, and complication rate.
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Affiliation(s)
- Xuelei Zhang
- Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, Sichuan Province, China
| | - Yu Zhang
- Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, Sichuan Province, China
| | - Zuchao Gu
- Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, Sichuan Province, China
| | - Guo Li
- Department of Orthopedics, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, Sichuan Province, China.
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Shang Q, Luan H, Peng C, Song X. Comparative effectiveness of cortical bone trajectory screws and pedicle screws in the treatment of adjacent segment degeneration after lumbar fusion surgery: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:380. [PMID: 38943143 PMCID: PMC11212258 DOI: 10.1186/s13018-024-04865-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. METHODS This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. RESULTS A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005]. CONCLUSION Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period.
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Affiliation(s)
- Qisong Shang
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Haopeng Luan
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Cong Peng
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China
| | - Xinghua Song
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830002, China.
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Wu C, Hu X, Liu R, Xu C, Jiang Y, Ge Z, Zhou K, Zhang D, Wu A, Dou H, Xu H, Tian N, Hu Z, Ni W. Comparison of the clinical and radiographic outcomes of cortical bone trajectory and traditional trajectory pedicle screw fixation in transforaminal lumbar interbody fusion: a randomized controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1069-1080. [PMID: 38246903 DOI: 10.1007/s00586-023-08086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE To compare the clinical outcomes and radiographic outcomes of cortical bone trajectory (CBT) and traditional trajectory (TT) pedicle screw fixation in patients treated with single-level transforaminal lumbar interbody fusion (TLIF). METHODS This trial included a total of 224 patients with lumbar spine disease who required single-level TLIF surgery. Patients were randomly assigned to the CBT and TT groups at a 1:1 ratio. Demographics and clinical and radiographic data were collected to evaluate the efficacy and safety of CBT and TT screw fixation in TLIF. RESULTS The baseline characteristic data were similar between the CBT and TT groups. Back and leg pain for both the CBT and TT groups improved significantly from baseline to 24 months postoperatively. The CBT group experienced less pain than the TT group at one week postoperatively. The postoperative radiographic results showed that the accuracy of screw placement was significantly increased in the CBT group compared with the TT group (P < 0.05). The CBT group had a significantly lower rate of FJV than the TT group (P < 0.05). In addition, the rate of fusion and the rate of screw loosening were similar between the CBT and TT groups according to screw loosening criteria. CONCLUSION This prospective, randomized controlled analysis suggests that clinical outcomes and radiographic characteristics, including fusion rates and caudal screw loosening rates, were comparable between CBT and TT screw fixation. Compared with the TT group, the CBT group showed advantages in the accuracy of screw placement and the FJV rate. CLINICAL TRIALS REGISTRATION This trial has been registered at the US National Institutes of Health Clinical Trials Registry: NCT03105167.
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Affiliation(s)
- Chenyu Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rongjie Liu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Cong Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Yi Jiang
- Beijing Haidian Hospital, Peking University, Beijing, China
| | - Zhaohui Ge
- Department of Spine Surgery, General Hospital of Ningxia Medical University, Ningxia, China
| | - Kailiang Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Di Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Aimin Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Haicheng Dou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Hui Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Naifeng Tian
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Zhichao Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Wenfei Ni
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China.
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Mao H, Wang Z, Li Q. The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta-analysis. Int Wound J 2023; 20:3241-3248. [PMID: 37264722 PMCID: PMC10502259 DOI: 10.1111/iwj.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023] Open
Abstract
A meta-analysis investigation was performed to measure the influence of cortical bone trajectory screw fixation (CBTSF) and traditional pedicle screw fixation (TPSF) on surgical site wound infection (SSWI) in posterior lumbar fusion (PLF). A comprehensive literature inspection till February 2023 was applied and 1657 interrelated investigations were reviewed. The 13 chosen investigations enclosed 1195 individuals with PLF in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the CBTSF and TPSF on SSWI in PLF by the dichotomous approaches and a fixed or random model. No significant difference was found between individuals using CBTSF and TPSF in SSWI (OR, 0.68; 95% CI, 0.35-1.33, P = .26), superficial SSWI (OR, 0.62; 95% CI, 0.22-1.79, P = .38), and deep SSWI (OR, 0.30; 95% CI, 0.06-1.50, P = .14) in PLF. No significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF. However, care must be exercised when dealing with its values because of the small sample sizes of several chosen investigations for this meta-analysis and the low number of selected investigations for a certain type of SSWI.
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Affiliation(s)
- Hanze Mao
- College of Acupuncture and OrthopedicsHubei University of Chinese MedicineWuhanChina
| | - Zhigang Wang
- Department of OrthopedicsAffiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese MedicineWuhanChina
| | - Qiang Li
- Department of Orthopedics and TraumatologyShaanxi Traditional Chinese Medicine HospitalXi'anChina
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Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
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Real-world data and evidence in pain research: a qualitative systematic review of methods in current practice. Pain Rep 2023; 8:e1057. [PMID: 36741790 PMCID: PMC9891449 DOI: 10.1097/pr9.0000000000001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/21/2022] [Accepted: 11/12/2022] [Indexed: 02/05/2023] Open
Abstract
The use of routinely collected health data (real-world data, RWD) to generate real-world evidence (RWE) for research purposes is a growing field. Computerized search methods, large electronic databases, and the development of novel statistical methods allow for valid analysis of data outside its primary clinical purpose. Here, we systematically reviewed the methodology used for RWE studies in pain research. We searched 3 databases (PubMed, EMBASE, and Web of Science) for studies using retrospective data sources comparing multiple groups or treatments. The protocol was registered under the DOI:10.17605/OSF.IO/KGVRM. A total of 65 studies were included. Of those, only 4 compared pharmacological interventions, whereas 49 investigated differences in surgical procedures, with the remaining studying alternative or psychological interventions or epidemiological factors. Most 39 studies reported significant results in their primary comparison, and an additional 12 reported comparable effectiveness. Fifty-eight studies used propensity scores to account for group differences, 38 of them using 1:1 case:control matching. Only 17 of 65 studies provided sensitivity analyses to show robustness of their findings, and only 4 studies provided links to publicly accessible protocols. RWE is a relevant construct that can provide evidence complementary to randomized controlled trials (RCTs), especially in scenarios where RCTs are difficult to conduct. The high proportion of studies reporting significant differences between groups or comparable effectiveness could imply a relevant degree of publication bias. RWD provides a potentially important resource to expand high-quality evidence beyond clinical trials, but rigorous quality standards need to be set to maximize the validity of RWE studies.
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Peng SB, Yuan XC, Lu WZ, Yu KX. Application of the cortical bone trajectory technique in posterior lumbar fixation. World J Clin Cases 2023; 11:255-267. [PMID: 36686364 PMCID: PMC9850973 DOI: 10.12998/wjcc.v11.i2.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/29/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
The cortical bone trajectory (CBT) is a novel technique in lumbar fixation and fusion. The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method. The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases, including spondylolisthesis or stenosis, and can also be used as a remedy for revision surgery when the pedicle screw fails. CBT has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. However, the concept of CBT internal fixation technology appeared relatively recently; consequently, there are few relevant clinical studies, and the long-term clinical efficacy and related complications have not been reported. Therefore, large sample and prospective studies are needed to further reveal the long-term complications and fusion rate. As a supplement to the traditional pedicle trajectory fixation technique, the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.
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Affiliation(s)
- Shi-Bo Peng
- Department of Orthopedics, Chongqing Nanchuan Hospital of Traditional Chinese Medicine, Chongqing 408400, China
| | - Xi-Chuan Yuan
- Department of Orthopedics, Chongqing Nanchuan Hospital of Traditional Chinese Medicine, Chongqing 408400, China
| | - Wei-Zhong Lu
- Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Ke-Xiao Yu
- Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
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Guo S, Zhu K, Yan MJ, Li XH, Tan J. Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis. World J Clin Cases 2022; 10:13179-13188. [PMID: 36683619 PMCID: PMC9850985 DOI: 10.12998/wjcc.v10.i36.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
Lumbar degenerative disc disease (DDD) in the elderly population remains a global health problem, especially in patients with osteoporosis. Osteoporosis in the elderly can cause failure of internal fixation. Cortical bone trajectory (CBT) is an effective, safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis. In this review, we analyzed the anatomy, biomechanics, and advantages of the CBT technique in lumbar DDD and revision surgery. Additionally, the clinical trials and case reports, indications, advancements and limitations of this technique were further discussed and reviewed. Finally, we concluded that the CBT technique can be a practical, effective and safe alternative to traditional pedicle screw fixation, especially in DDD patients with osteoporosis.
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Affiliation(s)
- Song Guo
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Kai Zhu
- Department of Orthopedics Ⅱ, Qingdao No. 8 People’s Hospital, Qingdao 266121, Shandong Province, China
| | - Mei-Jun Yan
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xin-Hua Li
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Jun Tan
- Department of Orthopedics, United Family Healthcare, Shanghai 200336, China
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Controversies in Spine Surgery: Is a Cortical Bone Trajectory Superior to Traditional Pedicle Screw Trajectory? Clin Spine Surg 2022; 35:225-228. [PMID: 32205518 DOI: 10.1097/bsd.0000000000000965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fujiwara S, Ohnishi Y, Iwatsuki K, Kishima H. Cortical bone trajectory fixation cause low compression force in anterior vertebral column. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100113. [PMID: 35434674 PMCID: PMC9005947 DOI: 10.1016/j.xnsj.2022.100113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Background The cortical bone trajectory (CBT) screws follow a caudocephalad and lateral path from the pedicle to the vertebral body. The bone fusion rate of CBT fixation is equal to or lower than conventional pedicle screw fixation. It remains unclear whether or not CVT screws exert equally compressive forces across the vertebral column. In this study, we intraoperatively examined the insertional torque of CBT screws, and investigated the compression loading and pressure distribution in conventional and CBT fixation using pig bones. Methods The insertional torque was measured for a total of 115 CBT screws. Detailed positions of these screws were retrospectively confirmed using CT scans. Screw loosening and interbody fusion were examined 1 year after surgery. In the experiment using pig bones, we inserted screws by conventional trajectory (n = 3) and CBT (n = 4). Results Multiple regression analysis showed that the total screw length, the distance from the screw to the medial border of the pedicle and the distance from the superior endplate of the vertebrae were significant independent factors affecting the insertional torque. There was no significant association between the insertional torque and the radiographic bone fusion rate 12 months after surgery. The average pressure and the compression loading in the anterior column were significantly lower in CBT group. Conclusion These results suggested that the long CBT screws as close to the endplate had high insertional torque, but the anterior column in CBT fixation showed low compression force leading to the insufficient holding intervertebral cage. CBT screws may cause the micromotion of cages, which lowers the bone fusion rate.
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Qiu L, Niu F, Wu Z, Zhang W, Chen F, Tan J, Yan J, Xia P. Comparative outcomes of cortical bone trajectory screw fixation and traditional pedicle screws in lumbar fusion: A meta-analysis. World Neurosurg 2022; 164:e436-e445. [PMID: 35533950 DOI: 10.1016/j.wneu.2022.04.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pedicular screws (PS) is often used in lumbar fusion. Cortical bone trajectory (CBT) is a novel technology in lumbar fusion with less clinical outcomes evidence. So we conduct a meta-analysis to compare the efficacy and safety between cortical bone trajectory screw fixation and traditional pedicle screws in lumbar fusion surgery. METHODS Multiple databases were searched for the articles about comparison of cortical bone trajectory (CBT) and traditional pedicle screws (PS) in lumbar fusion surgeries. The Meta-analysis was conducted by Revman 5.3 software. The following indicators were abstracted: visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA), surgical duration, complications, and blood loss. The quality of the articles was assessed by the Newcastle-Ottawa Scale or Cochrane Handbook. RESULTS 25 studies were included involving a total of 1735 patients. There is no difference in preoperative VAS scores, JOA, ODI, postoperative VAS scores and fusion rates. Besides, postoperative JOA(MD = 0.78, P = 0.02), ODI (MD = -2.09, P＝0.03), surgical duration(MD = -26.90, P = 0.02), complications(MD = 0.70, P = 0.03), and blood loss(MD = -85.27, P＝0.0009) showed greater improvement trends in CBT group than PS group with significant difference. CONCLUSION CBT reduced the rate of complications, surgical duration, blood loss, postoperative ODI and JOA scores. CBT technique with better postoperative outcomes achieved similar fusion rates compared with PS technique.
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Affiliation(s)
- Ling Qiu
- Xiaogan hosiptal of Chinese Medicine, 249 Huai-yin Road, Xiaogan 432100, P.R. China
| | - Fei Niu
- The Wuhan Hospital of Traditional Chinese And Western Medicine, 215 Zhong Shan Road, Wuhan 430022, P.R. China
| | - Zhedong Wu
- Hubei University of Chinese Medicine, 188 Tan Hua-lin Road, Wuhan 430065, P.R. China
| | - Wei Zhang
- The Wuhan Hospital of Traditional Chinese And Western Medicine, 215 Zhong Shan Road, Wuhan 430022, P.R. China
| | - Feifei Chen
- Xiaogan hosiptal of Chinese Medicine, 249 Huai-yin Road, Xiaogan 432100, P.R. China
| | - Jun Tan
- Xiaogan hosiptal of Chinese Medicine, 249 Huai-yin Road, Xiaogan 432100, P.R. China
| | - Jun Yan
- Xiaogan hosiptal of Chinese Medicine, 249 Huai-yin Road, Xiaogan 432100, P.R. China
| | - Ping Xia
- Hubei University of Chinese Medicine, 188 Tan Hua-lin Road, Wuhan 430065, P.R. China.
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Ding H, Hai Y, Liu Y, Guan L, Pan A, Zhang X, Han B, Li Y, Yin P. Cortical Trajectory Fixation Versus Traditional Pedicle-Screw Fixation in the Treatment of Lumbar Degenerative Patients with Osteoporosis: A Prospective Randomized Controlled Trial. Clin Interv Aging 2022; 17:175-184. [PMID: 35237030 PMCID: PMC8882472 DOI: 10.2147/cia.s349533] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/31/2022] [Indexed: 12/11/2022] Open
Abstract
Study Design Objective Methods Results Conclusion Trial Registration Number Date of Registration
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Affiliation(s)
- Hongtao Ding
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Yong Hai
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
- Correspondence: Yong Hai; Yuzeng Liu, Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China, Tel +86 10-85231229; +86 13801221889; +86 13811552832, Email ; ;
| | - Yuzeng Liu
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Li Guan
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Aixing Pan
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Xinuo Zhang
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Bo Han
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Yue Li
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Peng Yin
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
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Zhang RJ, Zhou LP, Zhang L, Zhang HQ, Ge P, Jia CY, Zhang Y, Zhang JX, Shen CL. The Rates and Risk Factors of Intra-Pedicular Accuracy and Proximal Facet Joint Violation for Single-Level Degenerative Lumbar Diseases: Cortical Bone Trajectory Versus Traditional Trajectory Pedicle Screw. Spine (Phila Pa 1976) 2021; 46:E1274-E1282. [PMID: 33907083 DOI: 10.1097/brs.0000000000004083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To compare the accuracy of pedicle screw placement and proximal facet joint violation (FJV) in single-level degenerative lumbar diseases using cortical bone trajectory (CBT) and traditional trajectory (TT) techniques, and analyze their possible risk factors. SUMMARY OF BACKGROUND DATA CBT screws have been utilized increasingly to improve cortical bone contact to prevent screw pullout and reduce approach-related morbidity. However, the studies on intra-pedicular accuracy and proximal FJV between the two methods are rare. METHODS A total of 40 patients who required single-level instruments were included in the retrospective study treated with the CBT-TLIF and the TT-TLIF at a 1:1 ratio from March 2019 to August 2020. The radiographic outcomes were the intra-pedicular accuracy and proximal FJV. Moreover, the possible risk factors were assessed using bivariate and multivariate analyses. RESULTS As for the intra-pedicular accuracy, 73 screws (91.3%) were classified as grade A, 7 screws (8.7%) classified as grade B in the CBT group. A total of 71 screws (88.8%) were graded A with remaining 8 screws (10.0%) graded B and 1 screw (1.2%) graded C in the TT group. The proportion of optimal and clinically acceptable screw positions in the two groups were not significantly different (P > 0.05). In addition, the rate of proximal FJV in CBT approach (8.3%) was significantly lower than that in the TT approach (35.0%) (P < 0.001). Multivariate analysis showed the TT insertion approach and facet angle ≥45° were the independent risk factors for proximal FJV, but no factors above affected intra-pedicular accuracy. CONCLUSION Compared with the TT approach in TLIF, the CBT approach showed similar intra-pedicular accuracy and remarkable superiority in proximal facet joint protection. Facet angle ≥45° is the independent risk factors for proximal FJV.Level of Evidence: 2.
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Affiliation(s)
- Ren-Jie Zhang
- Department of Orthopedics and Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Bielecki M, Kunert P, Balasa A, Kujawski S, Marchel A. Clinical and radiological results of treating lumbar spondylosis with cortical bone trajectory screws. Medicine (Baltimore) 2021; 100:e27670. [PMID: 34871243 PMCID: PMC8568361 DOI: 10.1097/md.0000000000027670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023] Open
Abstract
The cortical bone trajectory screws technique (CBTT) is a popular minimally invasive spine surgery. Few studies have reported long-term outcomes. We aimed to evaluate the complication profile and long-term follow-up results of patients with lumbar degenerative disease treated with the CBTT.This retrospective analysis included the first 40 consecutive patients that underwent the CBTT. The indication for surgery was critical stenosis of the intervertebral foramen, which required removal of the entire intervertebral joint, on at least 1 side, during decompression.The last follow-up showed minimal clinically important differences in the numerical rating scale of leg pain, the numerical rating scale of back pain, and the Oswestry Disability Index, in 97%, 95%, and 95% of patients, respectively. Thirty-nine patients completed long-term radiological follow-up. Computed tomography demonstrated solid bone union on 47 (92%) operated levels, collapsed union on 2 (4%) levels, nonunion on 1 (2%) level, and 1 (2%) patient was lost to follow-up. Seven patients experienced complications (4 hardware-related). Three patients required 4 revision surgeries.The CBTT effectively achieved spinal fusion; over 90% of patients achieved clinical improvement at a mean follow-up of 4.4 years (range: 3-5.75 years).
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Affiliation(s)
- Mateusz Bielecki
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Collegium, Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Sklodowskiej-Curie 9, Bydgoszcz, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Matsukawa K, Yanai Y, Fujiyoshi K, Kato T, Yato Y. Depth of vertebral screw insertion using a cortical bone trajectory technique in lumbar spinal fusion: radiological significance of a long cortical bone trajectory. J Neurosurg Spine 2021; 35:601-606. [PMID: 34388711 DOI: 10.3171/2021.2.spine202229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/11/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Contrary to original cortical bone trajectory (CBT), "long CBT" directed more anteriorly in the vertebral body has recently been recommended because of improved screw fixation and load sharing within the vertebra. However, to the authors' knowledge there has been no report on the clinical significance of the screw length and screw insertion depth used with the long CBT technique. The aim of the present study was to investigate the influence of the screw insertion depth in the vertebra on lumbar spinal fusion using the CBT technique. METHODS A total of 101 consecutive patients with L4 degenerative spondylolisthesis who underwent single-level posterior lumbar interbody fusion at L4-5 using the CBT technique were included (mean follow-up 32.9 months). Screw loosening and bone fusion were radiologically assessed to clarify the factors contributing to these outcomes. Investigated factors were as follows: 1) age, 2) sex, 3) body mass index, 4) bone mineral density, 5) intervertebral mobility, 6) screw diameter, 7) screw length, 8) depth of the screw in the vertebral body (%depth), 9) facetectomy, 10) crosslink connector, and 11) cage material. RESULTS The incidence of screw loosening was 3.1% and bone fusion was achieved in 91.7% of patients. There was no significant factor affecting screw loosening. The %depth in the group with bone fusion [fusion (+)] was significantly higher than that in the group without bone fusion [fusion (-)] (50.3% ± 8.2% vs 37.0% ± 9.5%, respectively; p = 0.001), and multivariate logistic regression analysis revealed that %depth was a significant independent predictor of bone fusion. Receiver operating characteristic curve analysis identified %depth > 39.2% as a predictor of bone fusion (sensitivity 90.9%, specificity 75.0%). CONCLUSIONS This study is, to the authors' knowledge, the first to investigate the significance of the screw insertion depth using the CBT technique. The cutoff value of the screw insertion depth in the vertebral body for achieving bone fusion was 39.2%.
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Uehara M, Takahashi J, Ikegami S, Tokida R, Nishimura H, Sakai N, Kuraishi S, Horiuchi H, Kato H. Values for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. J Orthop Sci 2021; 26:774-778. [PMID: 33309132 DOI: 10.1016/j.jos.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/03/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is widely used as a patient-based evaluation tool for lumbar spine disease in Japan. However, there are currently few established JOABPEQ reference values for the general population. This study proposes population-based reference values for JOABPEQ using a randomly sampled Japanese cohort. METHODS Registered citizens of 50-89 years old were targeted for this survey. We established 8 groups based on age (50's, 60's, 70's, and 80's) and gender (male and female) after random sampling from the basic resident registry of Obuse town in 2014. A total of 414 participants (202 males and 212 females) were enrolled for calculations of average JOABPEQ scores for each age and gender group. We also evaluated for correlations between JOABPEQ domain scores and visual analogue scale (VAS) scores for low back pain. RESULTS Median reference JOABPEQ scores stratified by age and gender were determined in this study. Lumbar function, walking ability, and social life function deteriorated significantly with age in both genders, with remarkable declines for the social life function domain. VAS scores for low back pain were not significantly correlated with JOABPEQ item scores. CONCLUSIONS This first resident cohort of Japanese individuals determined median JOABPEQ scores by age and gender, which might serve as reference values for future studies.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Ryosuke Tokida
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hikaru Nishimura
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Noriko Sakai
- Department of Orthopaedic Surgery, New Life Hospital, 851 Obuse, Kamitakai-gun, Nagano 381-0295, Japan
| | - Shugo Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Wang L, Zhao YH, Cai XB, Liang JL, Luo HT, Ma YL, Xu YQ, Lu S. Feasibility of cortical bone trajectory screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration. Medicine (Baltimore) 2021; 100:e26666. [PMID: 34260574 PMCID: PMC8284764 DOI: 10.1097/md.0000000000026666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To investigate the feasibility of using cortical bone trajectory (CBT) screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration and to provide a reference for clinical practice. METHODS Computed tomography scans of the lumbar spines of 36 patients in our hospital were used. Sixteen males and 20 females with an average age of 65.5 ± 10.5 years (range: 46 to 83 years) were included. Three-dimensional reconstruction was performed using computer software. Screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and traditional pedicle screws were placed using the standard method. After completing screw placement, simulated placement of CBT screws was performed separately. No overlap occurred between the two screws in the process of CBT screw placement, and the placement point and direction were adjusted until screw placement completion. After all screw placement simulations were complete, according to the contact area of the cortical bone of the screw trajectory and the screw puncture position and distance through the trajectory, the screw placement results were categorized as excellent, good, general, and failure. Excellent and good ratings were considered successful, while a general rating was regarded as acceptable. Then, the success rate and acceptable rate of each segment of the lumbar spine were calculated. RESULTS Three hundred and sixty screw placement simulations were performed in lumbar pedicles, and 72 CBT screws were implanted in each vertebral body of the lumbar spine. The success rates in the L1 to L5 segments were 73.6%, 80.6%, 83.3%, 88.9%, and 77.8%, respectively, and the acceptable rates were 91.7%, 97.2%, 97.2%, 100%, and 91.7%, respectively. The overall success rate and acceptable rate of CBT screw placement in the lumbar spine were 80.8% and 95.6%, respectively. CONCLUSION CBT screws are feasible for bridging fixation in lumbar adjacent segment degeneration revision surgery, and the accuracy of screw placement in different lumbar vertebrae varies.
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Affiliation(s)
- Long Wang
- Postgraduate College of Kunming Medical University, No. 1168 Chunrong Xi Road, Kunming, China
- Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, China
| | - Yong-Hui Zhao
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, China
| | - Xing-Bo Cai
- Postgraduate College of Kunming Medical University, No. 1168 Chunrong Xi Road, Kunming, China
- Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, China
| | - Jin-Long Liang
- Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, China
| | - Hao-Tian Luo
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, China
| | - Yu-Long Ma
- Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, China
| | - Yong-Qing Xu
- Department of Orthopedics, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, China
| | - Sheng Lu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, China
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Chang MC, Choo YJ, Lee GW. Pedicle screws versus cortical screws in posterior lumbar interbody fusion surgery for degenerative spondylolisthesis: a systematic review and meta-analysis. Spine J 2021; 21:1126-1134. [PMID: 33640584 DOI: 10.1016/j.spinee.2021.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A few meta-analyses have compared conventional pedicle screws (PS) with cortical bone trajectory-pedicle screws (cortical screw [CS]) in posterior lumbar fusion surgery. However, these studies did not control for diagnosis, which has been shown to impact surgical outcomes. PURPOSE To compare PS with CS as a posterior fixation technique in posterior lumbar interbody fusion (PLIF) for degenerative spondylolisthesis (DS). STUDY DESIGN Systematic review and meta-analysis. METHODS We searched the Cochrane, Embase, and Medline databases for articles that compared postoperative outcomes between PS and CS for posterior stabilization in PLIF for DS with November 11, 2020, as the publication cutoff. The differences in primary and secondary outcome measures were calculated and analyzed for significance (p<.05). All the reported means were pooled. RESULTS A total of 916 publications were assessed; 5 studies met all the study criteria. The fusion rates between PS and CS groups were not significantly different (p=.41). Blood loss and operative time were significantly less in the CS group than the PS group (p=.04 and 0.02, respectively), but the length of stay was not significantly different (p=.08). The total complication rate was significantly less in CS group than that in PS group (p=.002). The rates of adjacent segment pathology (ASP) and operation for ASP in the CS group were significantly less than the PS group (p=.03 and .04, respectively). CONCLUSIONS Though CS and PS appear to have similar 1-year fusion rates and length of stay, there appears to lower blood loss and operative time with CS. Though encouraging, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, South Korea
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, South Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, South Korea.
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Kumar KK, Parikh B, Jabarkheel R, Dirlikov B, Singh H. Fluoroscopic versus CT-guided cortical bone trajectory pedicle screw fixation: Comparing trajectory related complications. J Clin Neurosci 2021; 89:354-359. [PMID: 34088578 DOI: 10.1016/j.jocn.2021.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/23/2021] [Accepted: 05/23/2021] [Indexed: 01/02/2023]
Abstract
Cortical bone trajectory (CBT) pedicle screw fixation is an emerging technique for treatment of degenerative spine disease which requires either intraoperative fluoroscopy or intraoperative CT guidance (iCT). To date, there has been no direct comparison of these two navigation modalities; here we compare fluoroscopic versus iCT navigation for CBT pedicle screw fixation. We retrospectively reviewed all patients who underwent CBT screw fixation with either fluoroscopic or iCT guidance for lumbar degenerative disease by the senior author. Trajectory-related complications such as medial or lateral breach were compared on postoperative CT, in addition to the incidence of trajectory-related dural tear. We also compared general surgical complications such as postoperative infection and decompression related durotomies. Thirty-eight patients (19 fluoroscopic, 19 CT-guided) who underwent placement of 182 cortical screws (88 fluoroscopic, 94 CT-guided) were identified. In terms of trajectory-related complications, the iCT cohort had fewer medial breaches (1/94) compared to the fluoroscopic cohort (6/88) (p = 0.05). Each group had one lateral breach (p = 0.73). There was one case of CSF leak from screw placement in the fluoroscopic cohort, but none in the iCT cohort (p = 0.48). Overall, there were eight trajectory-related complications in the fluoroscopic cohort versus two in the iCT cohort (p = 0.04). Our data suggests statistically significant decreased trajectory-related complications with iCT-guided CBT screw fixation as compared to fluoroscopically guided. In terms of general surgical complications, while we observed increased postoperative infections in our fluoroscopic cohort, there was no statistically significant difference.
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Affiliation(s)
- Kevin K Kumar
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Bhavya Parikh
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | - Rashad Jabarkheel
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Harminder Singh
- Department of Neurosurgery, Stanford University, Stanford, CA, USA; Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, CA, USA.
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Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Maruo K, Arizumi F, Kusuyama K, Yoshie N, Tomoyuki K, Tachibana T. Comparison of Clinical Outcomes After Transforaminal Interbody Fusion Using Cortical Bone Trajectory versus Percutaneous Pedicle Screw Fixation. World Neurosurg 2021; 151:e821-e827. [PMID: 33964494 DOI: 10.1016/j.wneu.2021.04.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The study aim was to compare clinical outcomes between patients undergoing transforaminal lumbar interbody fusion (TLIF) using percutaneous pedicle screw (PPS) and cortical bone trajectory (CBT) by a single surgeon. METHODS This was a retrospective matched-cohort study of 77 patients (mean age, 71.7 years; 56% female) who underwent TLIF using CBT or PPS. Thirty-nine consecutive patients in the CBT group and 38 patients in the PPS group were matched for age, sex, and fused levels. All CBT screws were inserted by using a three-dimensional patient-specific guide (MySpine MC, Medacta). Perioperative outcomes of operative time, estimated blood loss, numeric rating scale scores, and serum concentration of creatine kinase were compared between the 2 groups. At 1 year postoperatively, clinical outcomes and radiographic outcomes, including cage subsidence, screw loosening, and fusion rates, were compared between the 2 groups. RESULTS The numeric rating scale scores on postoperative days 3 and 7 and serum creatine kinase levels on postoperative days 1 and 3 were significantly lower in the CBT group than in the PPS group (all P < 0.005). There were no significant intergroup differences in operation time and estimated blood loss. At postoperative 1 year, there were no significant differences in cage subsidence, screw loosening, and fusion rates between the CBT group and PPS group. Clinical outcomes were equivalent between the 2 groups. CONCLUSIONS The CBT technique using three-dimensional patient-specific guides resulted in lower perioperative pain and quicker recovery after surgery, which suggests that CBT is a less invasive procedure than PPS.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Norichika Yoshie
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kusukawa Tomoyuki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Zhao Y, Liang J, Luo H, Xu Y, Lu S. Double-trajectory lumbar screw placement guided by a set of 3D-printed surgical guide templates: a cadaver study. BMC Musculoskelet Disord 2021; 22:296. [PMID: 33752641 PMCID: PMC7983373 DOI: 10.1186/s12891-021-04149-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
Background To improve the strength of posterior spine fixation in patients with osteoporosis, some scholars have proposed a method of simultaneously inserting traditional pedicle screws and cortical bone trajectory screws into the pedicle. However, due to the difficulty of the operation and few clinical applications, the safety and accuracy of this method are still unclear. The purpose of this study was to investigate the safety and accuracy of double-trajectory lumbar screw placement guided by surgical guide templates. Methods Six wet lumbar specimens were selected for computed tomography (CT) scanning, a three-dimensional (3D) model of the lumbar spine was established using computer software, and surgical guide templates for double-trajectory [traditional pedicle trajectory (TPT) and cortical bone trajectory (CBT)] lumbar screw placement at various segments of the lumbar spine were designed and printed using a 3D printer. Screw placement was guided only by the surgical guide template, with no fluoroscopy. Postoperative CT examination was performed to determine whether the screw penetrated the screw path and the location and depth of penetration of the cortex. The preoperative and postoperative sagittal and axial angles of CBT screws or TPT screws were also measured and compared. Results Four screws were placed in each vertebral body of six lumbar specimens for a total of 120 screws. Screw grades: 99 screws as grade 0, 15 as grade 1, six as grade 2, and zero as grade 3. Thus, grade 0 accounted for 82.5% of the screws. No significant differences in the preoperative and postoperative angles of the screws were found (P > 0.05). Conclusions 3D-printed surgical guide templates for double-trajectory screw placement can reduce the difficulty of surgery and the use of intraoperative fluoroscopy. Using such templates is a safe, feasible, and accurate screw placement method.
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Affiliation(s)
- Yonghui Zhao
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Jinlong Liang
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, 212 Daguan Road, Kunming, 650032, Yunnan, China
| | - Haotian Luo
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Yongqing Xu
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, 212 Daguan Road, Kunming, 650032, Yunnan, China
| | - Sheng Lu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, Yunnan, China.
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Ding H, Han B, Hai Y, Liu Y, Guan L, Pan A, Liu T. The Feasibility of Assessing the Cortical Bone Trajectory Screw Placement Accuracy Using a Traditional Pedicle Screw Insertion Evaluation System. Clin Spine Surg 2021; 34:E112-E120. [PMID: 33633068 DOI: 10.1097/bsd.0000000000001059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 07/24/2020] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN This was a retrospective observational study. OBJECTIVE We aimed to characterize the feasibility of assessing the accuracy of cortical bone trajectory (CBT) screw placement in midline lumbar interbody fusion using a traditional pedicle screw insertion accuracy evaluation system based on computed tomography (CT). SUMMARY OF BACKGROUND DATA Since Santoni and colleagues proposed CBT as an alternative approach for the treatment of lumbar degenerative disease, CBT has been biomechanically and clinically investigated in detail. The reported misplacement rate was 0%-12.5%. Therefore, these cortical screws may result in severe complications, such as nerve root, vascular, and spinal cord injuries. However, to the best of our knowledge, the accuracy of the current assessment system of cortical bone screw placement has not been described clearly. MATERIALS AND METHODS Overall, 342 cortical screws of 69 consecutive patients with lumbar degenerative disease who underwent midline lumbar interbody fusion surgery in one surgeon's initial phase were examined retrospectively. A comprehensive and detailed pedicle screw accuracy classification and grading system was introduced in our study, including 5 types of misplacement: (1) medial and (2) lateral cortical bone perforation (MCP and LCP) of the corresponding pedicle, (3) anterior cortical bone perforation of the vertebral body, (4) endplate perforation, and (5) foraminal perforation (FP). The degree of interobserver and intraobserver agreement with regard to the screw positions based on CT were used as indicators of the reliability of the modified classification system. All patients were retrospectively assessed for screw placement-related complications throughout the entire treatment course to evaluate the relationship between the procedure adequacy and neurological symptoms. RESULTS The interobserver and intraobserver agreements were substantial-to-almost perfect (κ=0.78 and 0.88, respectively) in distinguishing the acceptable-placed pedicle screws from those with partial or complete cortical perforation. In the MCP and LCP-the most common types of misplacement-the interobserver agreement was substantial (κ=0.70 and 0.76, respectively), and the intraobserver agreement was almost perfect (κ=0.85 and 0.89, respectively). In total, there are 7 (2.05%) MCP and 65 (19.01%) LCP screws. The screw placement-related complication rate is significantly higher in the MCP and FP groups than that in the LCP group. CONCLUSIONS Our study demonstrated that using a pedicle screw classification and grading system based on CT to assess the accuracy of CBT screw placement is feasible and practical. MCP and FP screws are more likely to cause neurological deficits with statistical significance, especially grade 2 MCP. We recommend inexperienced surgeons choose a lateral trajectory rather than a medial one if they cannot ensure accurate screw insertion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hongtao Ding
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, Beijing, China
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Kovalenko RA, Kashin VA, Cherebillo VY. Individual Navigation Templates for Subcortical Screw Placement in Lumbar Spine. Sovrem Tekhnologii Med 2021; 13:41-46. [PMID: 35265348 PMCID: PMC8858410 DOI: 10.17691/stm2021.13.5.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 12/04/2022] Open
Abstract
Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation. The aim of the study was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy.
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Affiliation(s)
- R A Kovalenko
- Assistant, Department of Neurosurgery Pavlov First Saint Petersburg State Medical University, 6-8 L'va Tolstogo St., Saint Petersburg, 197022, Russia
| | - V A Kashin
- PhD Student, Department of Neurosurgery Pavlov First Saint Petersburg State Medical University, 6-8 L'va Tolstogo St., Saint Petersburg, 197022, Russia
| | - V Yu Cherebillo
- Professor, Head of the Department of Neurosurgery Pavlov First Saint Petersburg State Medical University, 6-8 L'va Tolstogo St., Saint Petersburg, 197022, Russia
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Inoue T, Mizutamari M, Hatake K. Surgical Invasiveness of Single-Segment Posterior Lumbar Interbody Fusion: Comparing Perioperative Blood Loss in Posterior Lumbar Interbody Fusion with Traditional Pedicle Screws, Cortical Bone Trajectory Screws, and Percutaneous Pedicle Screws. Asian Spine J 2020; 15:856-864. [PMID: 33371623 PMCID: PMC8696064 DOI: 10.31616/asj.2020.0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023] Open
Abstract
Study Design Single-center retrospective study. Purpose This study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS). Overview of Literature Intraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness. Methods This study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF). Results No significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50-367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260-760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180-890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145-637 mL) than in the PS-PLIF (639.6 mL; range, 285-1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270-950 mL; p=0.005) groups. Conclusions Based on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.
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Affiliation(s)
- Tetsuji Inoue
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Masaya Mizutamari
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Kuniaki Hatake
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
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Khan A, Rho K, Mao JZ, O’Connor TE, Agyei JO, Meyers JE, Mullin JP, Pollina J. Comparing Cortical Bone Trajectories for Pedicle Screw Insertion using Robotic Guidance and Three-Dimensional Computed Tomography Navigation. World Neurosurg 2020; 141:e625-e632. [DOI: 10.1016/j.wneu.2020.05.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022]
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Accuracy and safety of cortical bone trajectory screw placement by an inexperienced surgeon using 3D patient-specific guides for transforaminal lumbar interbody fusion. J Clin Neurosci 2020; 78:147-152. [DOI: 10.1016/j.jocn.2020.04.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022]
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Matsukawa K, Kato T, Mobbs R, Yato Y, Asazuma T. Combination of sacral-alar-iliac screw and cortical bone trajectory screw techniques for lumbosacral fixation: technical note. J Neurosurg Spine 2020; 33:186-191. [PMID: 32197252 DOI: 10.3171/2020.1.spine191420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbosacral fixation plays an important role in the management of devastating spinal pathologies, including osteoporosis, fracture, infection, tumor resection, and spinal deformities, which require long-segment fusion constructs to the sacrum. The sacral-alar-iliac (SAI) screw technique has been developed as a promising solution to facilitate both minimal invasiveness and strong fixation. The rationale for SAI screw insertion is a medialized entry point away from the ilium and in line with cranial screws. The divergent screw path of the cortical bone trajectory (CBT) provides a higher amount of cortical bone purchase and strong screw fixation and has the potential to harmoniously align with SAI screws due to its medial starting point. However, there has been no report on the combination of these two techniques. The objective of this study was to assess the feasibility of this combination technique. METHODS The subjects consisted of 17 consecutive patients with a mean age of 74.2 ± 4.7 years who underwent posterior lumbosacral fixation for degenerative spinal pathologies using the combination of SAI and CBT fixation techniques. There were 8 patients with degenerative scoliosis, 7 with degenerative kyphosis, 1 with an osteoporotic vertebral fracture at L5, and 1 with vertebral metastasis at L5. Fusion zones included T10-sacrum in 13 patients, L2-sacrum in 2, and L4-sacrum in 2. RESULTS No patients required complicated rod bending or the use of a connector for rod assembly in the lumbosacral region. Postoperative CT performed within a week after surgery showed that all lumbosacral screws were in correct positions and there was no incidence of neurovascular injuries. The lumbosacral bone fusion was confirmed in 81.8% of patients at 1-year follow-up based on fine-cut CT scanning. No patient showed a significant loss of spinal alignment or rod fracture in the lumbosacral transitional region. CONCLUSIONS This is the first paper on the feasibility of a combination technique using SAI and CBT screws. This technique could be a valid option for lumbosacral fixation due to the ease of rod placement with potential reductions in operative time and blood loss.
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Affiliation(s)
- Keitaro Matsukawa
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Takashi Kato
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Ralph Mobbs
- 2Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Sydney, Australia
| | - Yoshiyuki Yato
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
| | - Takashi Asazuma
- 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; and
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Nakajima N, Maenaka T, Kano H. Postoperative Low Back Pain after Posterior Lumbar Interbody Fusion Surgery Using Cortical Bone Trajectory Screws. Asian Spine J 2020; 14:655-662. [PMID: 32213798 PMCID: PMC7595813 DOI: 10.31616/asj.2019.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022] Open
Abstract
Study Design Retrospective analysis of a case series of prospectively collected data. Purpose To compare clinical and radiological outcomes between two posterior lumbar interbody fusion techniques: cortical bone trajectory (CBT) and traditional pedicle screw (PS). Overview of Literature Biomechanical studies have revealed the benefits of the CBT technique. However, clinical evidence obtained from the direct comparison of outcomes between CBT and PS is limited. Methods We retrospectively investigated 104 patients who had undergone posterior lumbar interbody fusion using CBT or PS. Clinical symptoms were evaluated and compared between CBT and PS using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Visual Analog Scale (VAS) before and 1 year after surgery. Spinal fusion status was assessed by multiplanar reconstruction computed tomography at 1 year after surgery. Results The CBT and PS techniques were performed on 36 and 68 patients, respectively. Both CBT- and PS-treated patients exhibited improvement in each subdomain of the JOABPEQ and in the VAS. With regard to postoperative improvement of low back pain, the treatment effect, as assessed by the JOABPEQ, was greater for PS than for CBT. The spinal fusion rate was slightly lower for CBT than for PS, although the difference between them was not significant. The effect of treatment on postoperative low back pain was smaller for CBT than for PS, regardless of whether rigid spinal fusion was achieved. Conclusions Clinical symptoms and spinal fusion efficiency were not significantly different between CBT and PS except for postoperative improvement in low back pain. The treatment effect on postoperative low back pain was smaller for CBT than for PS.
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Affiliation(s)
- Nozumu Nakajima
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takahiro Maenaka
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroki Kano
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Japan
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Han D, Wang J. Comparison of Different Insertion Techniques for Lumbosacral Fixation Improvement: A Finite Element Study. Orthop Surg 2020; 12:262-268. [PMID: 32077260 PMCID: PMC7031541 DOI: 10.1111/os.12624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We create a new S1 cortical screw trajectory technique using 3D reconstruction and the finite element (FE) method to provide a more reliable theoretical basis for clinical practices and to advance internal fixation technology for treatment of lumbosacral degenerative diseases. METHODS This retrospective study included patients (aged from 40 to 70 years) who needed intervertebral fusion surgery between August 2016 and August 2017. Data of patients with lumbosacral lesions was scanned and measured by 64-row spiral CT, and were then transmitted to the GE-AW4.3 post-processing system for 3D reconstruction. The trajectories of the three different screws were simulated by FE software and processed by mimics software to simulate the screw path: traditional PS fixation (Model A); traditional cortical screw (Model B); and new cortical screw (Model C). The CT value of the bone around the screw canal was recorded. Biomechanical effects of the three screws were analyzed and compared. RESULTS The displacement of flexion and extension, the vertebral body stress of right torsion, and the cage stress of flexion showed no significant differences among the three models (P > 0.05). The results demonstrated that cortical screws exceeded pedicle screws in stability and pullout force. Models B and C showed higher vertebral displacement in left bending (0.41 and 0.31 mm) and right bending (0.58 and 0.40 mm), lower vertebral body stress on extension (48.37 and 38.92 MPa), left bending (0.76 and 0.74 mm) and right bending (0.50 and 0.53 mm), and higher cage stress on left bending (162.19 and 160.63 MPa), right bending (150.02 and 150.05 MPa), left torsion (158.45 and 146.27 MPa) and right torsion (167.33 and 171.15 MPa) (all P < 0.05) compared to model A. Compared to Model B, Model C had higher displacement of left and right torsion, lower pressure in extension and flexion, and lower stress on cages in extension (P < 0.05). CONCLUSION The new cortical screw insertion method has similar effects to traditional cortical screw fixation. However, it demonstrated advantages in promoting lumbosacral interbody fusion, which protects vessels and nerves.
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Affiliation(s)
- Da‐peng Han
- Department of Spinal SurgeryShandong Province Hospital Affiliated to Shandong UniversityJinanChina
| | - Jia‐yin Wang
- Department of Spinal surgeryArmed Police Hospital of Shandong ProvinceJinanChina
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Cofano F, Marengo N, Ajello M, Penner F, Mammi M, Petrone S, Lavorato A, Zenga F, Garbossa D. The Era of Cortical Bone Trajectory Screws in Spine Surgery: A Qualitative Review with Rating of Evidence. World Neurosurg 2020; 134:14-24. [DOI: 10.1016/j.wneu.2019.10.079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 12/14/2022]
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Djurasovic M, Gum JL, Crawford CH, Owens K, Brown M, Steele P, Glassman SD, Carreon LY. Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion. J Neurosurg Spine 2020; 32:31-35. [PMID: 31518977 DOI: 10.3171/2019.6.spine1965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF. METHODS From a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D. RESULTS Of 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551). CONCLUSIONS Compared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.
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Affiliation(s)
| | | | | | - Kirk Owens
- 2Research, Norton Leatherman Spine Center, Louisville, Kentucky
| | - Morgan Brown
- 2Research, Norton Leatherman Spine Center, Louisville, Kentucky
| | | | | | - Leah Y Carreon
- 2Research, Norton Leatherman Spine Center, Louisville, Kentucky
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Laratta JL, Shillingford JN, Pugely AJ, Gupta K, Gum JL, Djurasovic M, Crawford CH. Accuracy of cortical bone trajectory screw placement in midline lumbar fusion (MIDLF) with intraoperative cone beam navigation. JOURNAL OF SPINE SURGERY 2019; 5:443-450. [PMID: 32042994 DOI: 10.21037/jss.2019.09.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cortical bone trajectory (CBT) screws have been recently described as a method of lumbosacral fixation. These screws are typically inserted under fluoroscopic guidance with a medial-to-lateral trajectory in the axial plane and a caudal-to-cephalad trajectory in the sagittal plane. In an effort to reduce surgeon radiation exposure and improve accuracy, CBT screws may be inserted under navigation with intraoperative cone beam computed tomography (CT). However, the accuracy of CBT screw placement under intraoperative navigation has yet to be assessed in the literature. The purpose of the study was to evaluate the accuracy of CBT screw placement using intraoperative cone beam CT navigation. Methods One hundred and thirty-four consecutive patients who underwent CBT fixation with 618 screws under intraoperative navigation were analyzed from May 2016 through May 2018. Screws were placed by one of three senior spine surgeons using the Medtronic O-Arm Stealth Navigation. Screw position and accuracy were assessed on intraoperative and postoperative CT scans using 2D and 3D reconstructions with VitreaCore software. Results The majority of surgeries were primary cases (73.1%). The mean age at the time of surgery was 61.5±10.0 years and the majority of patients were female (61.2%). Most patients underwent surgery for a diagnosis of degenerative spondylolisthesis (47.8%) followed by mechanical collapse with foraminal stenosis (22.4%). Ten violations of the vertebral cortex were noted with an average breach distance of 1.0±0.7 mm. Three breaches were lateral (0.5%) and seven were medial (1.1%). The overall navigated screw accuracy rate was 98.3%. The accuracy to within 1 mm of error was 99.2%. There were no intra-operative neurologic, vascular, or visceral complications related to the placement of the CBT screws. Conclusions CBT screw fixation under an intraoperative cone beam CT navigated insertion technique is safe and reliable. Despite five breaches greater than 1mm, there were no complications related to the placement of the CBT screws in this series.
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Affiliation(s)
- Joseph L Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Jamal N Shillingford
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | | | - Karishma Gupta
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Mladen Djurasovic
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, Louisville, KY, USA.,University of Louisville Medical Center, Louisville, KY, USA
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Zhang T, Guo N, Chen T, Yan J, Zhao W, Xu G. Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: a systematic review and meta-analysis. J Orthop Surg Res 2019; 14:269. [PMID: 31443671 PMCID: PMC6708162 DOI: 10.1186/s13018-019-1311-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose The clinical outcomes of using a cortical screw (CS) for lumbar interbody fusion were evaluated by comparison with conventional pedicle screw (PS) fixation. Methods All of the comparative studies published in the PubMed, Cochrane Library, MEDLINE, Web of Science, and EMBASE databases recently as 18 March 2019, were included. All outcomes were analyzed by using Review Manager 5.3. Results Twelve studies were included with a total of 835 patients, and two of the studies were randomized controlled trials. The outcomes of the meta-analysis indicated that the use of CS fixation for lumbar interbody fusion was better than conventional PS fixation in regard to operating time (p = 0.02), intraoperative blood loss (p < 0.00001), length of stay (p = 0.02), incidence of complications (p = 0.02), adjacent segmental disease (ASD) incidence (p = 0.03), and Oswestry Disability Index (ODI) (p = 0.03). However, there were no statistically significant differences in the back and leg pain visual analog scale (VAS), Japanese Orthopaedic Association (JOA) scale, and intervertebral fusion rate (all p > 0.05) between the CS fixation group and the PS fixation group. Conclusions Based on this systematic review and meta-analysis, our outcomes indicated that both CS and conventional PS can result in good postoperative outcomes in lumbar interbody fusion. No significant differences were found in the back and leg pain VAS, JOA scale, and intervertebral fusion rate. However, CS fixation is superior to PS fixation in the following measures: operating time, intraoperative blood loss, length of stay, incidence of complications, ASD incidence, and ODI. Trial registration PROSPERO registration number is CRD 42019132226.
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Affiliation(s)
- Tingxin Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Nana Guo
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Tiantian Chen
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Jinglong Yan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China
| | - Wei Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China.
| | - Gongping Xu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150081, China.
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Hu JN, Yang XF, Li CM, Li XX, Ding YZ. Comparison of cortical bone trajectory versus pedicle screw techniques in lumbar fusion surgery: A meta-analysis. Medicine (Baltimore) 2019; 98:e16751. [PMID: 31415372 PMCID: PMC6831251 DOI: 10.1097/md.0000000000016751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/15/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Biomechanical studies have demonstrated that cortical bone trajectory (CBT) screw can provide a 30% increase in uniaxial yield pullout load than pedicle screw (PS). In addition, the insertion torque of CBT screw is 1.71 times higher than that of PS. A meta-analysis was conducted to evaluate clinical results between CBT screw technique and PS technique in lumbar fusion surgery. METHODS An extensive search of literature was performed in PubMed, Embase, the Cochrane library. The following outcomes were extracted: visual analog scale (VAS), Oswestry disabilities index (ODI), Japanese Orthopaedic Association (JOA) score, complications, fusion rates, hospital stay, incision length, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 12 studies were included in the final analysis. The results indicated that CBT group with less blood loss [P < .01], less hospital stay [P < .01], and less incision length [P < .01] than PS group. There were no significant differences between 2 groups in other clinical parameters and outcomes. CONCLUSION CBT technique provided similar clinical outcomes and fusion rates compared to PS technique in lumbar fusion surgery. However, CBT technique provided additional benefits of less blood loss, less hospital stay, and less incision length.
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Accuracy of cortical bone trajectory screw placement using patient-specific template guide system. Neurosurg Rev 2019; 43:1135-1142. [DOI: 10.1007/s10143-019-01140-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
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Comparative clinical efficacy and safety of cortical bone trajectory screw fixation and traditional pedicle screw fixation in posterior lumbar fusion: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1678-1689. [DOI: 10.1007/s00586-019-05999-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/05/2019] [Indexed: 12/28/2022]
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Kaito T, Matsukawa K, Abe Y, Fiechter M, Zhu X, Fantigrossi A. Cortical pedicle screw placement in lumbar spinal surgery with a patient-matched targeting guide: A cadaveric study. J Orthop Sci 2018; 23:865-869. [PMID: 30042005 DOI: 10.1016/j.jos.2018.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cortical pedicle screw placement is an attractive technique in terms of both fixation strength and less invasiveness. However, to insert the screw with penetrating cortical bone on the ideal trajectory is technically demanding. The use of three-dimensional (3D) patient-matched guides may facilitate the use of this technique. PURPOSE To examine the accuracy of cortical screw placement using a patient-matched targeting guide with a cadaveric study assessing the accuracy. METHODS The 3D planning of the pedicle screw placement, including the location at which the screw would pass through the center of the pedicle, sagittal/transverse trajectory (angle), length, and diameter, was developed using 3D CAD design software. Three-dimensional guides based on the preoperative planning were created for three cadaveric specimens (L1 to S1, 36 pedicles). Screws (n = 18) and pins (n = 18) were placed using K-wire or drill-based guides, without X-ray exposure. Actual positioning was compared to the preoperative plan by superimposing the inserted screws/pins based on postoperative CT. The placement accuracy was graded based on the degree of perforation of the pedicle by the pedicle screw or pin using an acceptance criterion (no perforation; Grade A, 0-2 mm; Grade B, 2-4 mm; and Grade C, >4 mm). The mean deviation between the planned and inserted screw positions on the coronal plane at the midpoint of the pedicle was compared to the accuracy of screw guide for traditional pedicle screw trajectory (0.70 mm). RESULTS Of 35 evaluated screws and pins, 32 (91.4%) were inserted completely inside the pedicle. All pedicle perforation was within 2 mm. The mean deviation from the plan at the midpoint of pedicle was 0.66 mm; thus, the accuracy was within the predefined criteria. CONCLUSIONS Cortical pedicle screw placement using 3D-patient matched guides is accurate. Further clinical studies are required to confirm the radiographic and clinical effects.
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Affiliation(s)
- Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan.
| | - Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Japan
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Japan
| | | | - Xia Zhu
- Medacta International SA, Switzerland
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Abstract
STUDY DESIGN This is a retrospective analysis of electromyographic (EMG) stimulation thresholds of 64 cortical bone trajectory (CBT) screws. OBJECTIVE The authors seek to determine whether recordings below stimulation threshold correlate with CBT screw pedicle breach on computed tomographic imaging, and to explore which specific nerve roots are most at risk with this new trajectory. SUMMARY OF BACKGROUND DATA Intraoperative EMG monitoring has been utilized to verify accurate placement of pedicle screws. Although CBT screws are becoming increasingly popular, to the authors' knowledge there are no existing evaluations of the accuracy of intraoperative triggered EMG (tEMG) monitoring in this trajectory. MATERIALS AND METHODS Retrospective analysis of EMG stimulation thresholds of 64 CBT screws placed in patients at NYU Langone Medical Center from 2015-2017. EMG results including threshold values and muscle group stimulated were correlated with screw positioning determined on postoperative or intraoperative computed tomographic imaging. RESULTS In total, 4.7% of EMG threshold values indicated true breach, 1.6% were falsely positive for breach, 76.5% showed true absence of breach, 17.1% failed to reveal a present breach though 0% of medial breaches were undetected. L4 screws showed tEMG responses from adductor longus in 22%, L5 screws, from rectus femoris in 16.7%, and S1 screws from tibialis anterior in 50%. CONCLUSIONS tEMG testing is effective for medial breaches in CBT screws. In addition, there is evidence that bicortical placement of these screws causes lower stimulation values due to distal breach. Importantly, it seems that this is due in part to stimulation of the exiting nerve root at the level above.
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Kang MS, Lee YR, Hwang JH, Jeong ET, Son IS, Lee SH, Kim TH. A cross-sectional study of surgical glove perforation during the posterior lumbar interbody spinal fusion surgery: Its frequency, location, and risk factors. Medicine (Baltimore) 2018; 97:e10895. [PMID: 29851813 PMCID: PMC6393005 DOI: 10.1097/md.0000000000010895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Lumbar fusion surgery was known to pose a greater risk of surgical glove perforation. However, there has been no study on the glove perforation that can transmit the blood-borne disease to the patient and surgical staff members in the posterior lumbar interbody fusion surgery (PLIFs).We performed a cross-sectional study to investigate the glove perforation during the PLIFs. The study included 37 consecutive patients (10 males and 27 females). All used gloves of surgical staff members, which included the surgeon, assistant surgeons, bone trimmer (who performed local bone trimming and interbody cage preparation), and scrub nurse were collected and were performed to the pinhole water infusion test. The characteristics (i.e., frequency and location of perforated glove) and relative risk of glove perforation were investigated for each participant. The independent risk factors influencing glove perforation were analyzed by multiple logistic regression analysis.The overall operative perforation rate which is a percentage of detected more than one glove perforated event in all cases was 51.4%. The overall glove perforation rate which is the percentage of perforated gloves in all gloves used for surgery was 3.8%. The relative risk of glove perforation by each participant was 2.38 in the surgeon (P = .002), 1.36 in the bone trimmer (P = .04), 1.36 in the scrub nurse (P = .04), and 1.19 in assistant surgeons (P = .13). And, the volume of trimmed local bone was analyzed as an independent risk factor for glove perforation (ORs = 1.310, P = .02).The overall operative perforation rate in PLIFs is higher than 50%. The surgeon, scrub nurse and bone trimmer were observed as a significant risk factor for glove perforation. And, the volume of trimmed local bone was analyzed as independent risk factor. Since the preparation of the interbody cage is essential for successful lumbar fusion surgery, the bone trimmer must pay attention to the glove perforation during this procedure.
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Affiliation(s)
- Min Seok Kang
- Department of Orthopedic Surgery, Seoul Red Cross Hospital
| | | | - Jin Ho Hwang
- Department of Orthopedic Surgery, CM General Hospital
| | - Eun Taek Jeong
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - In Seok Son
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Suk Ha Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Hussain I, Virk MS, Link TW, Tsiouris AJ, Elowitz E. Posterior Lumbar Interbody Fusion with 3D-Navigation Guided Cortical Bone Trajectory Screws for L4/5 Degenerative Spondylolisthesis: 1-Year Clinical and Radiographic Outcomes. World Neurosurg 2018; 110:e504-e513. [DOI: 10.1016/j.wneu.2017.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 01/16/2023]
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Computer-assisted Patient-specific Prototype Template for Thoracolumbar Cortical Bone Trajectory Screw Placement: A Cadaveric Study. Tech Orthop 2017; 33:246-250. [PMID: 30542224 PMCID: PMC6250272 DOI: 10.1097/bto.0000000000000285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cortical bone trajectory (CBT) screw technique yields effective mechanical and clinical results, improving the holding screw strength with a less invasive exposure. Accurate and safe screw placement is crucial. A patient-specific drill template with a preplanned trajectory was considered a promising solution; however, it is critical to assess the efficacy and safety of this technique. This study aims to evaluate the accuracy of patient-specific computed tomography (CT)-based rapid prototype drill guide templates for the CBT technique. CT scanning was performed in 7 cadaveric thoracolumbar spines, and a 3-dimensional reconstruction model was generated. By using computer software, we constructed drill templates that fit onto the posterior surface of thoracolumbar vertebrae with drill guides to match the CBT. In total, 80 guide templates from T11 to L5 were created from the computer models by using rapid prototyping. The drill templates were used to guide the drilling of CBT screws without any fluoroscopic control, and CT images were obtained after fixation. The entry point and direction of the planned and inserted screws were measured and compared. In total, 80 screws were inserted from T11 to L5. No misplacement or bony perforation was observed on postoperative CT scan. The patient-specific prototype template system showed the advantage of safe and accurate cortical screw placement in the thoracolumbar spine. This method showed its ability to customize the patient-specific trajectory of the spine, based on the unique morphology of the spine. The potential use of drill templates to place CBT screws is promising.
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Phan K, Ramachandran V, Tran TM, Shah KP, Fadhil M, Lackey A, Chang N, Wu AM, Mobbs RJ. Systematic review of cortical bone trajectory versus pedicle screw techniques for lumbosacral spine fusion. JOURNAL OF SPINE SURGERY 2017; 3:679-688. [PMID: 29354747 DOI: 10.21037/jss.2017.11.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws. This study aims to review the available evidence to assess the merits of the CBT approach. Six electronic databases were searched for original published studies which compared CBT with traditional PS and their findings reviewed. Nine comparative studies were identified through a comprehensive literature search. Studies were classified as retrospective cohort, prospective cohort or case control studies with medium quality as assessed by the GRADE criteria. The available literature is not cohesive regarding outcomes and complications of CBT versus PT procedures. Most studies found no difference in operative time, but reported less blood loss during CBT. Radiological outcomes show no difference in slippage at one year although CBT is associated with greater bone-density compared to PT. Results for post-operative pain are inconclusive.
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Affiliation(s)
- Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
| | | | - Tommy M Tran
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kevin P Shah
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Fadhil
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alan Lackey
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - Nicholas Chang
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Center, the Second Affiliated Hospital, Hangzhou 310000, China.,Department of Spine Surgery, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales (UNSW), Randwick, Sydney, Australia
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