Introduction A prospective comparative study between classical posterior interbody fusion with peduncular screws and the new technique with divergent cortical screws was conducted. Material and Methods Only patients with monosegmental degenerative disease were recruited into this study. We analyzed a cohort of 40 patients treated from January 2015 to March 2016 divided into 2 groups (20 patients went to traditional open surgery and 20 patients under mini-invasive strategy). Primary endpoints of this study are fusion rate and muscular damage; secondary endpoints analyzed were three different clinical scores (ODI, VAS, and EQ) and the morbidity rate of both techniques. Results There was no significant difference in fusion rate between the two techniques. In addition, a significant difference in muscular damage was found according to the MRI evaluation. Clinical outcomes, based on pain intensity, Oswestry Disability Index status, and Euroquality-5D score, were found to be also statistically different, even one year after surgery. This study also demonstrated a correlation between patients' muscular damage and their clinical outcome. Conclusions Cortical bone trajectory screws would provide similar outcomes compared to pedicle screws in posterior lumbar interbody fusion at one year after surgery, and this technique represents a reasonable alternative to pedicle screws.
Introduction
First advocated by Santoni et al. in 2009, the cortical bone trajectory (CBT) pedicle
screw technique is an alternative to the traditional, convergent technique that shows
comparable biomechanical features and potentially requires less aggressive tissue
retraction. Aim of this therapeutical note is to describe this new technique focusing on
main advantages and limitations.
Material and Methods
The authors provide a detailed description of the surgically relevant anatomy focusing
on the positioning of the cortical trajectory screws. The surgical technique is then
described in a precise step-by-step manner, stressing complication avoidance.
Results and Conclusion: The maximal access surgery PLIF approach is a
safe, reproducible procedure allowing for a traditional lumbar spine approach with the
benefits of minimal facet joint manipulation and potentially preserving part of their
neural innervation and a large part of the paraspinous musculature. A dedicated
self-retaining retractor and directional neuromonitoring may guide surgeons during the
procedure. Nevertheless, the surgeon's knowledge of anatomical landmarks, response to
visual and tactile cues and intraoperative decision-making skills remain of paramount
importance.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.