Cortical Bone Trajectory Screws in Posterior Lumbar Interbody Fusion: Minimally Invasive Surgery for Maximal Muscle Sparing—A Prospective Comparative Study with the Traditional Open Technique

Marengo, Nicola; Ajello, Marco; Pecoraro, Michele Federico; Pilloni, Giulia; Vercelli, Giovanni; Cofano, Fabio; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego

doi:10.1155/2018/7424568

Cited by 40 publications

(48 citation statements)

References 14 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: 86%

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: 86%

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

“…Moreover, they have been demonstrated to have a superior fixation strength and good stiffness in flexion and extension. 8,11,[34][35][36][37] This technical note and case series is, to our knowledge, the first clinical description on the use of a patient-matched guide for posterior CBT screw placement. Only cadaveric studies have existed until now.…”

Section: Discussionmentioning

confidence: 89%

“…Regarding long-term outcomes, there has not been any validated data, but good expectations are generally anticipated, as suggested by several studies. [6][7][8][9][10][11][12] Accurate screw placement in spinal surgery has always been a challenge for surgeons. Many technologies and useful tools have been developed in recent years, including fluoroscopy, navigation software, electrical conductivityebased systems, neuromonitoring, and custom-made template guides.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Increased blood loss during lumbar fixation has been correlated with increased muscle damage. 18 Another theoretical advantage of decreased blood loss is a subsequent decreased risk of blood transfusion and other complications in patients with comorbid conditions who are more sensitive to lower postoperative hemoglobin levels. Indeed, no patients in the CBT group required a postoperative blood transfusion.…”

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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Cortical Bone Trajectory Screws in Posterior Lumbar Interbody Fusion: Minimally Invasive Surgery for Maximal Muscle Sparing—A Prospective Comparative Study with the Traditional Open Technique

Cited by 40 publications

References 14 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

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

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

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