Differences in bone mineral density of fixation points between lumbar cortical and traditional pedicle screws

Harry, T.; Mitchell, Sean M.; Hashmi, Salman; Jenkins, Tyler J.; Patel, Alpesh A.; Hsu, Wellington K.

doi:10.1016/j.spinee.2015.11.034

Cited by 51 publications

(47 citation statements)

References 28 publications

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“…This may prevent complications and facilitate postoperative relief for certain spinal geometric distortions and deformities. Thus, during the last decade, vertebral augmentation with cement, kyphoplasty and vertebroplasty [23,24], in conjunction with pedicle screwbased approaches [25][26][27] have been used for treating severe spinal deformities.…”

Section: Discussionmentioning

confidence: 99%

Considering the lumbosacral geometry as a functional matrix predicting the development of spine derangement and low back pain

Anibeze¹,

Ossi²,

Ani³

et al. 2019

biomedicalresearch

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Purpose: The contribution of lumbosacral geometry to the development of spine anomalies is unclear. This study tested whether sacral base angle (SBA), lumbar gravity line position (GL) and patient height (HP) are associated with low back pain (LBP) and spondylolisthesis. The study aimed to determine the validity of SBA and GL in radiological evaluation and as factors that predisposes the lumbosacraAl junction (LSJ) to certain derangements. Materials and Methods: The prospective study involved 488 adult patients. Patients with non-injury related LBP (84) and those (46) without LBP; age range: 16-80 years were included. The remaining patients (358) with injury-related LBP were excluded. Digital images of antero-posterior and lateral views of the lumbosacral spine of the patients were blindly examined by two consultant radiologists. Pathologies were identified and classified according to age and sex. SBA and GL were determined using Ferguson's methods and height was measured using a health scale. Results: SBA (odds ratio: 1.045, P<0.05) and GL (odds ratio: 0.265, P<0.05) were significant factors predicting the development of LBP and spondylolisthesis, respectively. GL was found to be related to SBA (r=-0.409, p<0.01). Occurrence of LBP did not depend on age, sex, or HP. Discussion and Conclusion: SBA and GL are factors that should be considered when diagnosing noninjury related LBP and spondylolisthesis, respectively, as well as for correction of LSJ geometric distortion and when considering activities associated with transfer of large weights at the LSJ.

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Section: Discussionmentioning

confidence: 99%

Considering the lumbosacral geometry as a functional matrix predicting the development of spine derangement and low back pain

Anibeze¹,

Ossi²,

Ani³

et al. 2019

biomedicalresearch

View full text Add to dashboard Cite

show abstract

“…In this study, we used clinical data from DXA and CT to define the regional bone qualities (cHU, mHU, lUH, fHU, and pHU) considering various conditions of general bone qualities (BMD). DXA is a useful tool for assessing general bone quality due to its convenience, while HU values obtained from CT are strong indicators for evaluating regional bone quality, so these two tools have been used to determine general and local bone quality . However, there are other factors that influence the real strength of bone (such as structural factors and vector of force), and the HU value is not a direct reflection of the strength of bone; therefore, mechanical tests should be conducted to minimize bias and present the real strength data …”

Section: Discussionmentioning

confidence: 99%

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

Kim

Cho

Kwak

et al. 2017

Journal Orthopaedic Research

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This study aimed to report the mechanical strength and characteristics of the lateral mass and pedicle considering BMD for the safe insertion of pedicle screws in the subaxial cervical level. We evaluated BMD and Hounsfield unit (HU) values of cortical bones at the lateral mass and pedicle of C3-7 from CT images in 99 patients. Patients were divided into three groups (Group A, T-score ≥ -1; Group B, -2.5 < T-score < -1.0; Group C, T-score ≤ -2.5). The HU numbers of cortical bone in the vertebral canal (medial wall of the lateral mass; cHU), posterior wall of the transverse foramen (fHU), and medial wall, lateral wall, and trabecular area of the pedicle (mHU, lHU, and pHU, respectively) were measured on the CT images in the middle of the pedicle. A mechanical study was also performed to measure cortical bone strength using 10 fresh cadavers. The cHU and mHU values in Group C were higher than lHU and fHU in Groups A and B, and there was a wide gap between the pHU value and other areas. The penetrating force also had a close correlation with HU number. The mean penetrating force of the medial wall of the lateral mass and the posterior wall of the transverse foramen were 210.08 ± 110.46 and 50.51 ± 46.09 N, respectively. The cortical bones in the vertebral canal and medial wall of the pedicle were stronger than the lateral wall and the trabecular area. The cHU and mHU in the osteoporotic group were higher than fHU and pHU in the normal group. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:217-223, 2018.

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“…CT analyses demonstrated that Hounsfield units along CBT, even with shorter and smaller bone paths, were four times higher than those along TT 13) , and this tendency was prominent with increasing generation 14) . Theoretically, CBT can achieve a 4-point cortical contact between the dorsal starting point, inferomedial pedicle wall, anterolateral pedicle wall, and lateral curvature of the vertebral endplate ( Fig.…”

Section: Anatomical Characteristicsmentioning

confidence: 93%

Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints

Matsukawa

Yato

2017

Spine Surg Relat Res

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Abstract:Over the past few decades, many attempts to enhance the integrity of the bone-screw interface have been made to prevent pedicle screw failure and to achieve a better clinical outcome when treating a variety of spinal disorders. Cortical bone trajectory (CBT) has been developed as an alternative to the traditional lumbar pedicle screw trajectory. Contrary to the traditional trajectory, which follows the anatomical axis of the pedicle from a lateral starting point, CBT starts at the lateral part of the pars interarticularis and follows a mediolateral and caudocranial screw path through the pedicle. By markedly altering the screw path, CBT has the advantage of achieving a higher level of thread contact with the cortical bone from the dorsal entry point to the vertebral body. Biomechanical studies demonstrated the superior anchoring ability of CBT over the traditional trajectory, even with a shorter and smaller CBT screw. Furthermore, screw insertion from a more medial and caudal starting point requires less exposure and minimizes the procedure-related morbidity, such as reducing damage to the paraspinal muscles, avoiding iatrogenic injury to the cranial facet joint, and maintaining neurovascular supply to the fused segment. Thus, the features of CBT, which enhance screw fixation with limited surgical exposure, have attracted the interest of surgeons as a new minimally invasive method for spinal fusion.The purpose of this study was: 1) to identify the features of the CBT technique by reviewing previous anatomical and biomechanical literature, and 2) to describe its clinical application with a focus on the indications, limitations, surgical technique, and clinical evidence.

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Differences in bone mineral density of fixation points between lumbar cortical and traditional pedicle screws

Cited by 51 publications

References 28 publications

Considering the lumbosacral geometry as a functional matrix predicting the development of spine derangement and low back pain

Considering the lumbosacral geometry as a functional matrix predicting the development of spine derangement and low back pain

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints

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