Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

Marengo, Nicola; Matsukawa, Keitaro; Monticelli, Matteo; Ajello, Marco; Pacca, Paolo; Cofano, Fabio; Penner, Federica; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego

doi:10.1016/j.wneu.2019.05.241

Cited by 38 publications

(28 citation statements)

References 37 publications

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“…However, a divergent screw trajectory, such as that performed with the cortical bone trajectory (CBT) technique, allows benefits from TG technology and also permits minimal invasiveness. [30][31][32][33] The size of the skin incision is reported to be approximately 5 cm for a singlelevel instrumentation, and the transverse processes do not have to be exposed. 32 Current research at our institution compares the differences of a standard trajectory to CBT within another RCT.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

Spirig¹,

Golshani

Farshad‐Amacker

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVE Patient-specific template-guided (TG) pedicle screw placement currently achieves the highest reported accuracy in cadaveric and early clinical studies, with reports of reduced use of radiation and less surgical time. However, a clinical randomized controlled trial (RCT) eliminating potential biases is lacking. This study compares TG and standard freehand (FH) pedicle screw insertion techniques in an RCT. METHODS Twenty-four patients (mean age 64 years, 9 men and 15 women) scheduled consecutively and independently from this study for 1-, 2-, or 3-level lumbar fusion were randomized to either the FH (n = 12) or TG (n = 12) group. Accuracy of pedicle screw placement, intraoperative parameters, and short-term complications were compared. RESULTS A total of 112 screws (58 FH and 54 TG screws) were implanted in the lumbar spine. Radiation exposure was significantly less in the TG group (78.0 ± 46.3 cGycm2) compared with the FH group (234.1 ± 138.1 cGycm2, p = 0.001). There were 4 pedicle screw perforations (6.9%) in the FH group and 2 (3.7%) in the TG group (p > 0.99), with no clinical consequences. Clinically relevant complications were 1 postoperative pedicle fracture in the FH group (p > 0.99), 1 infection in the FH group, and 2 infections in the TG group (p > 0.99). There were no significant differences in surgical exposure time, screw insertion time, overall surgical time, or blood loss between the FH and TG groups. CONCLUSIONS In this RCT, patient-specific TG pedicle screw insertion in the lumbar region achieved a high accuracy, but not better than a standardized FH technique. Even if intraoperative radiation exposure is less with the TG technique, the need for a preoperative CT scan counterbalances this advantage. However, more difficult trajectories might reveal potential benefits of the TG technique and need further research.

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Section: Discussionmentioning

confidence: 99%

Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

Spirig¹,

Golshani

Farshad‐Amacker

et al. 2021

Journal of Neurosurgery: Spine

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“…Simulation has demonstrated its utility in trainee learning, 11,39 and we think that the simulator that we proposed can be useful for improving the learning curve of CBT, and obtaining satisfactory results during its implementation in the neurosurgical department. However, other systems have been also described that facilitate the implementation of CBT such as 3D preoperative CT planning 38 and patient-matched printed guides, 40,41 which facilitate screw introduction and minimize complications.…”

Section: Discussionmentioning

confidence: 99%

Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement

Delgado-Fernández

Frade-Porto

Blasco

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background and Objective Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications. Methods We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed. Results During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 0.034). In our retrospective series, eight patients with L4–L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; p = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure. Conclusion The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.

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“…Furthermore, similar technique used by Marengo et al suggested that 3D-printed guides may reduce the incidence of nerve damage 60 . While further clinical data and investigations are necessary to test the safety and efficacy of 3D-printed guides and other such adjuncts to CBT, these studies are suggestive of the potential future for CBT and spinal surgery in general, where advancements in patient outcome are propagated by combining medicine with industry innovations.…”

Section: Evolution Of Technique and Directions For The Futurementioning

confidence: 95%

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

Kim¹,

Mobbs²,

Natarajan³

et al. 2022

Spine Surg Relat Res

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was the principal author, responsible for conducting the literature review and writing the primary manuscript. R.J. Mobbs provided the direction for the paper, provided a clinical background to CBT and the figures displayed in this manuscript, and revised the first manuscript. P. Natarajan and R.D. Fonseka assisted with data/literature collection and provided revisions of the final manuscript. W.R. Walsh provided biomechanical background to the CBT to the primary author and reviewed the final manuscript. Ethics ApprovalNo ethics approval was not required as this was a historical review paper and did not require (1) biomechanical testing using cadaveric/animal specimen or (2) any clinical participants.

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Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

Cited by 38 publications

References 37 publications

Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement

Historical Note: The Evolution of Cortical Bone Trajectory and Associated Techniques

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