Radiological Evaluation of the Initial Fixation between Cortical Bone Trajectory and Conventional Pedicle Screw Technique for Lumbar Degenerative Spondylolisthesis

Abstract Background Pedicle screw fixation the gold standard for lumbar spine stabilization. Pedicle screw has fixation offers multiple advantages, allowing superior correction of spinal deformities, and reduced rates of loss of non-union. Cortical Bone Trajectory (CBT) is a new technique in which screws follow a caudal-to-cephalad path in the sagittal plane and a medial-to-lateral directed path in the transverse plane. CBT is reducing operative and post-operative complications and has high fixation strength. Purpose To Compare the clinical outcomes between CBT and traditional trajectory (TT) in surgical management of degenerative spondylolisthesis. Materials and Methods A comprehensive electronic search in Pubmed, MEDLINE and Chocrane library databases, Google scholar and Research gate for articles that published between 2009 to 2020 using these keywords: Cortical bone trajectory, Cortical bone trajectory-pedicle screw, Pedicle screw. Results The majority of literature suggests that the CBT technique results in similar or decreased postoperative back and leg pain compared to TT. Regarding the disability ODI and the operative time showed no significant differences between the CBT and TT. Radiographic outcomes between both studies show no statistical difference in fusion rates and vertebral slippage. Intraoperative blood loss was significantly less with CBT compared to TT. Conclusion there is no widely accepted consensus regarding comparison of clinical outcomes and complications between the CBT and TT procedures. Generally, indications for CBT and TT are similar between most studies, especially for common pathologies resulting in spondylolisthesis.

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Comparison of facet joint violation in lumbar posterior spinal instrumentation using different techniques including cortical bone trajectory

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720903471 ◽

2020 ◽

Vol 27 (1) ◽

pp. 57-62

Author(s):

CY To ◽

P Cheung ◽

W Ng ◽

WY Mok

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Facet Joint ◽

Spinal Instrumentation ◽

Entry Site ◽

Cortical Bone Trajectory ◽

Percutaneous Pedicle Screw ◽

Iatrogenic Damage ◽

Percutaneous Screws ◽

Facet Joint Violation

Study background: A retrospective study to compare the rate of facet joint violation (FJV) in lumbar posterior spinal instrumentation using open pedicle screw, percutaneous pedicle screw, and cortical bone trajectory (CBT) technique. CBT is a new posterior spinal instrumentation technique in which a more caudal entry point can minimize iatrogenic damage to the cranial facet joint. Only one recent study reports incidence of FJV of 11%; however, no previous reports comment on radiological outcomes comparing to traditional open and percutaneous screws. Methods: We reviewed 90 patients who underwent lumbar posterior spinal instrumentation from January 2016 to June 2017. Postoperative computer tomography scans were performed to evaluate FJV. Incidence of FJV was graded by three reviewers according to Seo classification. Results: Totally, 446 screws (open 43.4%, percutaneous 37.8%, CBT 18.9%) were inserted. Among these, 6.3% (28/446) had screw head or rod in contact with facet joint and 0.9% (4/446) had screws directly invaded the facet joint. Overall, FJV was 7.2% (CTB = 3.4%, open = 10.4%, and percutaneous = 4.5%, p = 0.075). Conclusion: CBT technique has potential advantage in reducing FJV. It has a unique entry site at lateral aspect of pars interarticular with a caudomedial to craniolateral pathway. It is a reasonable alternative to open or percutaneous techniques in lumbar posterior spinal instrumentation.

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Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Spine ◽

10.1097/brs.0000000000001459 ◽

2016 ◽

Vol 41 (14) ◽

pp. E851-E856 ◽

Cited By ~ 27

Author(s):

Keitaro Matsukawa ◽

Takashi Kato ◽

Yoshiyuki Yato ◽

Hiroshi Sasao ◽

Hideaki Imabayashi ◽

...

Keyword(s):

Risk Factors ◽

Cortical Bone ◽

Pedicle Screw ◽

Facet Joint ◽

Cortical Bone Trajectory ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Facet Joint Violation

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Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study

Journal of Neurosurgery Spine ◽

10.3171/2016.3.spine151525 ◽

2016 ◽

Vol 25 (5) ◽

pp. 591-595 ◽

Cited By ~ 34

Author(s):

Hironobu Sakaura ◽

Toshitada Miwa ◽

Tomoya Yamashita ◽

Yusuke Kuroda ◽

Tetsuo Ohwada

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Surgical Outcomes ◽

Recovery Rate ◽

Interbody Fusion ◽

Screw Fixation ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Cortical Bone Trajectory

OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation. METHODS Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated. RESULTS The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p < 0.05). Solid spinal fusion was achieved in 84 patients from the CBT group (88.4%) and in 79 patients from the PS group (96.3%, p > 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p < 0.05). CONCLUSIONS PLIF with CBT screw fixation for DS provided comparable improvement of clinical symptoms with PLIF using traditional PS fixation. However, the successful fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.

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Cortical Bone Trajectory versus Percutaneous Pedicle Screw in Minimally Invasive Posterior Lumbar Fusion

The Spine Journal ◽

10.1016/j.spinee.2014.08.286 ◽

2014 ◽

Vol 14 (11) ◽

pp. S114-S115 ◽

Cited By ~ 10

Author(s):

Ivan Gonchar ◽

Yoshihisa Kotani ◽

Yusuke Matsumoto

Keyword(s):

Minimally Invasive ◽

Cortical Bone ◽

Pedicle Screw ◽

Lumbar Fusion ◽

Cortical Bone Trajectory ◽

Posterior Lumbar Fusion ◽

Percutaneous Pedicle Screw

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Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children: technical note

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds17240 ◽

2018 ◽

Vol 21 (2) ◽

pp. 190-196 ◽

Cited By ~ 3

Author(s):

Jonathan N. Sellin ◽

Jeffrey S. Raskin ◽

Kristen A. Staggers ◽

Alison Brayton ◽

Valentina Briceño ◽

...

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Spine Surgery ◽

Intraoperative Complications ◽

Thoracolumbar Spine ◽

Pedicle Screws ◽

Instrumented Fusion ◽

Cortical Bone Trajectory ◽

Estimated Blood Loss ◽

Posterior Instrumented Fusion

Thoracic and lumbar cortical bone trajectory pedicle screws have been described in adult spine surgery. They have likewise been described in pediatric CT-based morphometric studies; however, clinical experience in the pediatric age group is limited. The authors here describe the use of cortical bone trajectory pedicle screws in posterior instrumented spinal fusions from the upper thoracic to the lumbar spine in 12 children. This dedicated study represents the initial use of cortical screws in pediatric spine surgery.The authors retrospectively reviewed the demographics and procedural data of patients who had undergone posterior instrumented fusion using thoracic, lumbar, and sacral cortical screws in children for the following indications: spondylolysis and/or spondylolisthesis (5 patients), unstable thoracolumbar spine trauma (3 patients), scoliosis (2 patients), and tumor (2 patients).Twelve pediatric patients, ranging in age from 11 to 18 years (mean 15.4 years), underwent posterior instrumented fusion. Seventy-six cortical bone trajectory pedicle screws were placed. There were 33 thoracic screws and 43 lumbar screws. Patients underwent surgery between April 29, 2015, and February 1, 2016. Seven (70%) of 10 patients with available imaging achieved a solid fusion, as assessed by CT. Mean follow-up time was 16.8 months (range 13–22 months). There were no intraoperative complications directly related to the cortical bone trajectory screws. One patient required hardware revision for caudal instrumentation failure and screw-head fracture at 3 months after surgery.Mean surgical time was 277 minutes (range 120–542 minutes). Nine of the 12 patients received either a 12- or 24-mg dose of recombinant human bone morphogenic protein 2. Average estimated blood loss was 283 ml (range 25–1100 ml).In our preliminary experience, the cortical bone trajectory pedicle screw technique seems to be a reasonable alternative to the traditional trajectory pedicle screw placement in children. Cortical screws seem to offer satisfactory clinical and radiographic outcomes, with a low complication profile.

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Balancing Rigidity and Safety of Pedicle Screw Fixation via a Novel Expansion Mechanism in a Severely Osteoporotic Model

BioMed Research International ◽

10.1155/2015/318405 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Thomas M. Shea ◽

James J. Doulgeris ◽

Sabrina A. Gonzalez-Blohm ◽

William E. Lee ◽

Kamran Aghayev ◽

...

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Cortical Layer ◽

Fixation Strength ◽

Osteoporotic Bone ◽

Pullout Strength ◽

Initial Fixation ◽

Increased Risk

Many successful attempts to increase pullout strength of pedicle screws in osteoporotic bone have been accompanied with an increased risk of catastrophic damage to the patient. To avoid this, a single-armed expansive pedicle screw was designed to increase fixation strength while controlling postfailure damage away from the nerves surrounding the pedicle. The screw was then subsequently tested in two severely osteoporotic models: one representing trabecular bone (with and without the presence of polymethylmethacrylate) and the other representing a combination of trabecular and cortical bone. Maximum pullout strength, stiffness, energy to failure, energy to removal, and size of the resulting block damage were statistically compared among conditions. While expandable pedicle screws produced maximum pullout forces less than or comparable to standard screws, they required a higher amount of energy to be fully removed from both models. Furthermore, damage to the cortical layer in the composite test blocks was smaller in all measured directions for tests involving expandable pedicle screws than those involving standard pedicle screws. This indicates that while initial fixation may not differ in the presence of cortical bone, the expandable pedicle screw offers an increased level of postfailure stability and safety to patients awaiting revision surgery.

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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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