Cortical Bone Trajectory for Lumbar Pedicle Screw Placement: A Review of Published Reports

Phan, Kevin; Hogan, Jarred; Maharaj, Monish; Mobbs, Ralph J.

doi:10.1111/os.12185

Cited by 76 publications

(70 citation statements)

References 35 publications

(60 reference statements)

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“…The criterion for controlling the values of entire lumbosacral motion was adapted as a reasonable approach to evaluate implant-induced effects on the adjacent segments. 11,14,15 The applied displacement onto the L1 vertebra ensured the disc ROMs of the adjacent, transition, and fixation segments of the healthy model comparable to the cadaveric data obtained from the study by Yamamoto et al 23 The disk ROM was defined as the difference between disk angles before and after lumbar motion. The nonlinear algorithm with a large-deformation formula and direct-sparse solver was used in the software Simulation Ed.…”

Section: Finite Element Analyses and Validationmentioning

confidence: 91%

“…10 Overall, there is evidence for CBT to exert similar or reduced postoperative pain and blood loss compared to the TT technique. [11][12][13] The decrease in postoperative bed-time was attributed to the smaller incision size, decreased disruption of muscle attachment, and soft-tissue dissection using CBT. 14 Varieties of spinal dynamic fixators have been used such as Cosmic or Dynesys systems (pedicle screw implants) and DIAM and Corflex (interspinous process implant).…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Liu

Wang

et al. 2019

Preprint

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Background To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) provide equivalent pull-out strengths of a screw. Dynesys fixation of TT screws, but not dynamization of CBT screws, has been used extensively in lumbar surgery. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization.Methods A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison.Results The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking.Conclusions A systematic analysis of the effects of TT and CBT fixation constructs on kinematic and kinetic responses in a full lumbosacral model is currently lacking. This study examined both the static fixation effect and its dynamic counterpart and identified that dynamization of CBT have slightly inferior structural stiffness than dynamic TT and cautious preoperative evaluation is essential if 3.5-mm diameter CBT screws are used. Therefore, 4.5-mm or 5.5-mm diameter CBT screws, or as big as tolerated, are recommended to avoid loosening and cracking.

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Section: Finite Element Analyses and Validationmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Liu

Wang

et al. 2019

Preprint

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“…The role of retractor sleeve/towers for use with cortical bone trajectory/Medio‐Latero‐Supero Technique (MLST) trajectory screws is yet to be explored and will likely revolve around the use of flexible retractor options (Fig. ) . As yet, there are no published technical reports of such options and devices; however, with the expanding range of indications for cortical bone trajectory/MLST screws, similar minimally invasive surgery (MIS) options involving percutaneous sleeves/towers that provide access for pedicle screws using this technique will likely become available in the future.…”

Section: Future Directionsmentioning

confidence: 99%

History of Retractor Technologies for Percutaneous Pedicle Screw Fixation Systems

Mobbs

Phan

2016

Orthopaedic Surgery

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Minimally invasive techniques aimed at minimizing surgery-associated risk and morbidity of spinal surgery have increased in popularity in recent years. Their potential advantages include reduced length of hospital stay, blood loss, and requirement for post-operative analgesia and earlier return to work. One such minimally invasive technique is the use of percutaneous pedicle screw fixation, which is paramount for promoting rigid and stable constructs and fusion in the context of trauma, tumors, deformity and degenerative disease. Percutaneous pedicle screw insertion can be an intimidating prospect for surgeons who have only been trained in open techniques. One of the ongoing challenges of this percutaneous system is to provide the surgeon with adequate access to the pedicle entry anatomy and adequate tactile or visual feedback concerning the position and anatomy of the rod and set-screw construct. This review article discusses the history and evolution of percutaneous pedicle screw retractor technologies and outlines the advances over the last decade in the rapidly expanding field of minimal access surgery for posterior pedicle screw based spinal stabilization. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery techniques and associated technologies will also multiply. It is important that experienced surgeons have access to tools that can improve access with a greater degree of ease, simplicity and safety. We here discuss the technical challenges of percutaneous pedicle screw retractor technologies and a variety of systems with a focus on the pros and cons of various retractor systems.

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“…[8][9][10][11][12][13][14] 피질골 척추경 나사못 기기는 비교적 최근에 소개된 것으로, 기존의 척추경 나사못의 삽입 방향이 아니라 척추경의 내측 하 부에서 외측 상부 방향으로 피질골 나사못을 삽입하여 척추경 중 피질골이 가장 많은 부분에 피질골 나사못을 통과시킴으로 써 견고한 고정력을 얻는 방법이다. 이 술식은 Santoni 등 15) 에 의 해 최초로 소개된 뒤, 퇴행성 및 골다공증성 척추에서 기존의 척 추경 나사못과 유사한 고졍력을 유지하면서도 보다 적은 절개로 시행이 가능한 것으로 알려져 있으며 여러 생역학적 연구들 [16][17][18][19] 과 임상 연구들 [20][21][22][23][24][25][26][27]…”

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Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis: Preliminary Report

Kim

Park

Rhyu

2016

J Korean Soc Spine Surg

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Study Design: Retrospective clinical study. Objectives: To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. Summary of Literature Review: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders. Materials and Methods: Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups. Results: Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases. Conclusions: The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis. 서론척추의 감염성 질환은 전체 근골격계 감염성 질환의 2~7%에 서 발생하며, 약 95%에서 척추체와 추간판을 침범하고 5% 정 도에서는 후방 구조물을 침범한다. 1-3) 대부분의 척추추간판염의 경우, 항생제 투여, 침상 안정, 보조기 착용 등의 비수술적 치료 로 좋은 임상 결과를 얻을 수 있다. 그러나 항생제 투여에도 감 염이 소실되지 않는 경우, 신경학적 이상이 진행하는 경우, 심한 골파괴로 척추의 불안정성이나 변형이 있는 경우, 심한 통증이 있는 경우, 임상적으로 중요한 농양이 형성된 경우에는 수술적 치료를 시행하게 된다. 4-7) 수술적 치료로는 전방 감압, 변연 절제 및 유합술이 널리 사용되고 있으며, 초기에는 수술적 치료에서

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Cortical Bone Trajectory for Lumbar Pedicle Screw Placement: A Review of Published Reports

Cited by 76 publications

References 35 publications

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

History of Retractor Technologies for Percutaneous Pedicle Screw Fixation Systems

Surgical Usage of a Cortical Bone Trajectory Pedicle Screw to Treat Lumbar Pyogenic Spondylodiscitis: Preliminary Report

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