Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis

Sakaura, Hironobu; Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yoshio; Ohwada, Tetsuo

doi:10.3171/2017.5.spine161154

Cited by 57 publications

(76 citation statements)

References 16 publications

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“…The results were consistent with that in similar cohorts [31]. The average surgical time ranged from 117.8min to 237.6min [8,20], and 119ml to 276.5ml [21,32] for intraoperative blood loss in previous studies of single level cortical screw fixation surgery [21,[32][33][34].…”

Section: More Familiar With Surgical Procedures: a Natural Processsupporting

confidence: 85%

“…The superior pullout strength, higher insertional torque and satisfactory stability of the screw-rod construction compared to the traditional fixation have been confirmed by biomechanical studies [7,10,[12][13][14][15][16][17][18]. And the comparable clinical outcomes, less multifidus muscle damage and less complications associated with instrumentations compared to PS have been observed in clinical studies [19][20][21][22][23][24]. However, the CBT screws placement accuracy, surgical parameters and complications in one surgeon's learning curve could rarely be found in literature.…”

Section: Introductionmentioning

confidence: 78%

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The safety and effectiveness of MIDLF during one surgeon’s initial phase: accuracy, clinical outcome, complications and learning curve

Ding¹,

Hai²,

Liu³

et al. 2020

Preprint

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ObjectiveTo characterize the safety and effectiveness during one surgeon’s initial phases of performing a Midline lumbar fusion by freehand technique based on perioperative parameters.MethodsThe first 90 consecutive patients underwent single level MIDLF, utilized a consistent technique, performed by one surgeon were retrospectively studied. A piecewise regression analysis was performed to evaluate the operation duration based on case number, and to estimate the breakpoint. The early learning period and the late steady phase was divided according to the case number of the breakpoint. Perioperative parameters and clinical data of 2 groups were compared then to elucidate if improvement in operative duration was accompanied by better patient prognosis.ResultsThe inflectional asymptote of the surgeon’s learning curve for MIDLF was achieved at the 40th case. The demographics parameters were similar between the early group of 40 patients and the latter 50. Average surgical time, intraoperative blood loss, length of incision, duration of drainage, postoperative drainage and post-operative hospitalization were significantly less in the late cohort (p<.05). Medial cortical breach was observed in 6/360 cases (4 vs. 2, P>.05), and lateral cortical breach was observed in 35/360 cases (24 vs.11, P<.05). One case of cerebrospinal fluid (CSF) leak, two cases of durotomy and one case of nerve root injury related to the technique was found in the early group, and only one case of durotomy was found in the late group. Post-surgical wound infection was seen in 2.22% (N = 2/90) of patients (2 vs. 0, P>.05). The overall complication incidence decreased alone with the learning curve, and statistical difference was achieved. Furthermore, there was no difference in clinical improvement between the two groups.ConclusionsOur result indicated that technical proficiency in MIDLF was achieved after 40 surgeries. And it is effective to significantly improve the patients’ functional status and relief the pain during one surgeon’s learning process of MIDLF in the treatment of lumbar degenerative disease, even in the initial phase. As the surgeon gains surgical proficiency and familiarity with MIDLF procedure, potential complications could be minimized. Furthermore, our results provided evidence to the excellent performance as an alternative option to traditional pedicle screw fixation.

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Section: More Familiar With Surgical Procedures: a Natural Processsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 78%

The safety and effectiveness of MIDLF during one surgeon’s initial phase: accuracy, clinical outcome, complications and learning curve

Ding¹,

Hai²,

Liu³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Although this difference has been seen in some studies, 11,13,16 others have reported similar EBL. 17 As with operative time, differences in surgeon familiarity with the technique and body mass index among patient cohorts can potentially obscure the perceived benefits of the less invasive exposure associated with CBT screws. Increased blood loss during lumbar fixation has been correlated with increased muscle damage.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the largest CBT screw cohort to date did not report on the incidence of screw pullout or loosening. 17 Larger comparison studies are needed to determine whether or not the biomechanical advantages of CBT screws can be replicated in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Cortical Bone Trajectory Screw Placement Using the Midline Lumbar Fusion Technique to Traditional Pedicle Screws: A Case-Control Study

et al. 2019

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Background: Cortical bone trajectory (CBT) screws are an alternative to traditional pedicle screws (PS) for lumbar fixation. The proposed benefits of CBT screws include decreased approach-related morbidity and greater cortical bone contact to prevent screw pullout. Relatively little data is published on this technique. Here, we compare the midline lumbar fusion (MIDLF) approach for CBT screw placement to transforaminal lumbar interbody fusion (TLIF) for traditional PS placement. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients undergoing lumbar spinal fusion using CBT screws over the past 5 years. Controls were identified from the same database as patients undergoing lumbar spinal fusion with traditional PS placement and matched based on age, sex, and number of levels fused. Exclusion criteria included prior lumbar instrumentation. The electronic health record was retrospectively reviewed for demographic, perioperative, and postoperative data. Results: A total of 23 patients who underwent CBT screw placement and 35 controls who received traditional PS were included in the study. The median follow-up time was 52.5 months. The CBT screw group had significantly less mean estimated blood loss than the PS group (186 mL versus 414 mL respectively; P ¼ .008). Both groups experienced significant improvements in preoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. However, there was no significant difference between the groups in regard to operative time and amount of improvement in VAS pain score or ODI. The CBT group was associated with a significantly shorter mean length of stay (LOS). There were 2 instances of screw pullout in each group. Conclusions: The MIDLF approach with CBT screw placement is associated with less intraoperative blood loss and shorter LOS than traditional PS placement. There is no difference between the 2 techniques in regard to improvement in pain or disability.

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“…The screw is placed at an inward and outward tilt to maximize the contact with cortical bone. It has the advantages of strong control, less trauma, fewer complications, less intraoperative bleeding and lower postoperative infection rate [14][15][16], which has a broad clinical value and application prospect. However, there are still risks and postoperative complications in clinical practice, including failure of internal fixation, pedicle splitting, pseudarthrosis and dural tear.…”

Section: Development Change and Limitation Of Spinal Fixation Technomentioning

confidence: 99%

Imaging anatomy and clinical significance of percutaneous endoscopic transforaminal oblique fixation from posterior corner in lumbar spine

Chen

Liu

Sun

et al. 2020

Preprint

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BackgroundPercutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been widely discussed due to its advantages of less trauma, less bleeding, quick recovery, high safety, and relatively fewer complications, as well as other adverse factors such as incomplete decompression, steep learning curve, low fusion rate, and high radiation risk. It can keep the posterior structure of spine intact to the greatest extent, ensure the stability of spine after surgery, and achieve decompression with minor trauma. However, posterior percutaneous pedicle screws are often needed for fusion and fixation after decompression, and additional posterior trauma, postural changes and anesthesia methods are often required. Interbody fixation and fusion are often independent and not one-stop completion. The authors consider whether the percutaneous spinal endoscopy can be used to achieve complete decompression and fusion under a single minimally invasive channel, while achieving one-stop endoscopic decompression, fusion and fixation. The purpose of this paper is to provide the anatomic feasibility for oblique fixation by measuring the imaging anatomic parameters, especially to provide the anatomic basis for the design of new endoscopic lumbar interbody fusion cage.Methods Sixty volunteers (22 men and 38 women) who underwent lumbar CT scans were collected and sent to the GEAW4.4 workstation. The distances from posterior corner in the lumbar spine to the corresponding targets of the contralateral anterior corner and the included angles between each path line in sagittal and axial plane were measured and analyzed statistically.Results In the medium group, PC path was the shortest, PA path and PB path had little difference (P=0.123), with no statistical significance. In the full-length group, PF path was the shortest, and there was no significant difference between PD path and PE path (P =0.177). PE was the optimal path. The included angles a1, a2, a3, b1, b2, and b3 in sagittal plane and c1, c2 and c3 in axial plane were significantly different (P=0.000), namely, a1 >a2>a3, b1>b2>b3, and c1<c2<c3. Conclusions This study provides anatomic feasibility for percutaneous endoscopic transforaminal oblique fixation from posterior corner in lumbar spine and particularly provides anatomic basis for the design of new endoscopic lumbar interbody fusion cage.

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Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis

Cited by 57 publications

References 16 publications

The safety and effectiveness of MIDLF during one surgeon’s initial phase: accuracy, clinical outcome, complications and learning curve

The safety and effectiveness of MIDLF during one surgeon’s initial phase: accuracy, clinical outcome, complications and learning curve

Comparison of Cortical Bone Trajectory Screw Placement Using the Midline Lumbar Fusion Technique to Traditional Pedicle Screws: A Case-Control Study

Imaging anatomy and clinical significance of percutaneous endoscopic transforaminal oblique fixation from posterior corner in lumbar spine

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