Feasibility of cortical bone trajectory screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

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Novel placement of cortical bone trajectory screws in previously instrumented pedicles for adjacent-segment lumbar disease using CT image-guided navigation

Neurosurgical FOCUS ◽

10.3171/2014.1.focus13521 ◽

2014 ◽

Vol 36 (3) ◽

pp. E9 ◽

Cited By ~ 48

Author(s):

Analiz Rodriguez ◽

Matthew T. Neal ◽

Ann Liu ◽

Aravind Somasundaram ◽

Wesley Hsu ◽

...

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Screw Fixation ◽

Lumbar Fusion ◽

Pedicle Screw Fixation ◽

Adjacent Segment ◽

Average Hospital ◽

Cortical Bone Trajectory ◽

Image Guided

Object Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation. Methods The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained. Results The average patient age was 69.4 years (range 58–82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175–315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2–3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10–15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B. Conclusions The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.

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Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20238 ◽

2020 ◽

pp. 1-6

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Jeremy M. V. Guinn ◽

Joshua Rivera ◽

Sigurd H. Berven ◽

...

Keyword(s):

Revision Surgery ◽

Demographic Data ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Fat Infiltration ◽

Single Level ◽

Goutallier Classification ◽

Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

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Preliminary study of the use of a CBT screw to treat lumbar adjacent segment degeneration

10.21203/rs.2.17729/v1 ◽

2019 ◽

Author(s):

Yonghui Zhao ◽

Jinlong Liang ◽

Haotian Luo ◽

Yulong Ma ◽

Taibang Chen ◽

...

Keyword(s):

Lumbar Spine ◽

Success Rate ◽

Revision Surgery ◽

Three Dimensional ◽

Lumbar Vertebra ◽

Reference Value ◽

Adjacent Segment Degeneration ◽

Screw Placement ◽

Adjacent Segment ◽

Success Rates

Abstract Objective: To investigate the feasibility of using the cortical bone trajectory (CBT) screw in revision surgery for lumbar adjacent segment degeneration (LASD) and to provide a reference for clinical practice.Methods:The computed tomography (CT) scans of the lumbar spine of 40 patients in our hospital were used. Three-dimensional (3D) reconstruction was performed using Mimics 19.0 software, screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and the traditional pedicle (TP) screws were placed using the standard method. After the completion of screw placement, the simulated placement of CBT screws with appropriate sizes was performed separately. During screw placement, the site and the direction were adjusted accordingly to complete the screw placement as much as possible. Under the premise of safe and feasible placement, penetration of the screw through the CBT and overlap between the TP and CBT screws should be avoided. If these requirements are met, screw placement is considered successful. Otherwise, the screw placement is considered failed. After all simulated screw placements were complete, the success rate of the screw placement in each segment of the lumbar vertebra was calculated from the statistical results. Finally, the pedicle trajectory reference width (TRW) was used for grouping to investigate the correlation between the TRW and sucess rate of screw placement. Results: Four hundred simulated screw placements (80 in each pedicle) were performed in the L1-L5 pedicles. The overall success rate of CBT screw placement in the lumbar spine was 57.00%. The success rates in the L1 to L5 segments were 47.50%, 62.50%, 57.50%, 70.00%, and 47.50%, respectively. The success rate in L4 was greater than in L2 and L3, while the lowest success rates were observed in L1 and L5. The groups were established based on the TRW. The success rate of CBT screw placement increased as the TRW increased.Conclusions: CBT screws are not suitable treatments for all cases of LASD. The success rate of screw placement varies in different lumbar segments. A preoperative measurement of TRW has important reference value for evaluating the feasibility of CBT screw placement in revision surgery for LASD.

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