In Vivo Analysis of Insertional Torque During Pedicle Screwing Using Cortical Bone Trajectory Technique

Matsukawa, Keitaro; Yato, Yoshiyuki; Kato, Takashi; Imabayashi, Hideaki; Asazuma, Takashi; Nemoto, Koichi

doi:10.1097/brs.0000000000000116

Cited by 203 publications

(186 citation statements)

References 25 publications

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“…22 It has also been reported, in terms of mechanical behavior in vivo, that the insertional torque of pedicle screws using the CBT technique was 71% higher than that of the TT technique. 19 Even though the superior stability of axial screw fixation using CBT has been demonstrated, little is known about the biomechanical stiffness of the screw-bone interface against multidirectional loading. Furthermore, there are some concerns about the fixation stability of CBT.…”

Section: 23mentioning

confidence: 99%

“…To achieve a simulation resembling a clinical situation, the TT screw was 6.5 mm in diameter and 40 mm in length, and the CBT screw was 5.5 mm in diameter and 35 mm in length. 19 Each screw was carefully placed in the appropriate position to prevent any cortical breaching and bicortical purchase into the anterior vertebral body because these two conditions may potentially influence screw fixation values.…”

Section: Insertional Trajectorymentioning

confidence: 99%

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Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Matsukawa

Yato

Imabayashi

et al. 2015

SPI

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107

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OBJECT Cortical bone trajectory (CBT) maximizes thread contact with the cortical bone surface and provides increased fixation strength. Even though the superior stability of axial screw fixation has been demonstrated, little is known about the biomechanical stiffness against multidirectional loading or its characteristics within a unit construct. The purpose of the present study was to quantitatively evaluate the anchorage performance of CBT by the finite element (FE) method. METHODS Thirty FE models of L-4 vertebrae from human spines (mean age [± SD] 60.9 ± 18.7 years, 14 men and 16 women) were computationally created and pedicle screws were placed using the traditional trajectory (TT) and CBT. The TT screw was 6.5 mm in diameter and 40 mm in length, and the CBT screw was 5.5 mm in diameter and 35 mm in length. To make a valid comparison, the same shape of screw was inserted into the same pedicle in each subject. First, the fixation strength of a single pedicle screw was compared by axial pullout and multidirectional loading tests. Next, vertebral fixation strength within a construct was examined by simulating the motions of flexion, extension, lateral bending, and axial rotation. RESULTS CBT demonstrated a 26.4% greater mean pullout strength (POS; p = 0.003) than TT, and also showed a mean 27.8% stronger stiffness (p < 0.05) during cephalocaudal loading and 140.2% stronger stiffness (p < 0.001) during mediolateral loading. The CBT construct had superior resistance to flexion and extension loading and inferior resistance to lateral bending and axial rotation. The vertebral fixation strength of the construct was significantly correlated with bone mineral density of the femoral neck and the POS of a single screw. CONCLUSIONS CBT demonstrated superior fixation strength for each individual screw and sufficient stiffness in flexion and extension within a construct. The TT construct was superior to the CBT construct during lateral bending and axial rotation.

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Section: 23mentioning

confidence: 99%

Section: Insertional Trajectorymentioning

confidence: 99%

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Matsukawa

Yato

Imabayashi

et al. 2015

SPI

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107

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“…Moreover, only a few studies have reported the biomechanical, clinical, and radiological outcomes in actual surgical cases (3,9). Therefore, the data on this technique are as yet limited.…”

Section: Future Investigationmentioning

confidence: 99%

“…For the right and left CBT screw insertion, the points are at 7 o'clock and 5 o'clock of the pedicle, respectively (Figure 4). This is similar to the technique proposed by Matsukawa et al (3). The lateral view on the image intensifier is used to understand the sagittal trajectory of CBT screwing ( Figure 5).…”

Section: Surgical Techniquementioning

confidence: 99%

Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: A technical note

et al. 2014

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: The pedicle screw (PS) system is widely used for spinal reconstruction. Recently, screw insertion using the cortical bone trajectory (CBT) technique has been reported to provide increased holding strength of the vertebra, even in an osteoporotic spine. CBT is also beneficial due to its low invasiveness. We have been performing hybrid reconstruction with CBT at the cranial level and PS at the caudal level based on the concept of minimal invasiveness. We applied this hybrid technique to 6 cases of degenerative spondylolisthesis. Surgery was completed with a small skin incision of around 5-6 cm, which is shorter than that of the conventional PS procedure. The mean percent slippage before surgery was 19.8% %, and this was reduced to 3.9% % after surgery and almost maintained 3 months after surgery. Furthermore, no major surgical complications were observed. Here, we introduce the minimally invasive hybrid technique of CBT-PS. Surgeons should be aware of the procedure as an option for minimally invasive lumbar spine reconstructive surgery.

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“…More practically replicating a mechanism of pedicle screw loosening, Baluch et al compared the fixation strength of CBT screws (average 4.5-mm diameter and 32-mm length) with that of TT screws (average 6.5-mm diameter and 45-mm length) under cyclic loads perpendicular to the screw axis, and demonstrated the superior resistance of CBT screws 23) . Another study also evaluated the mechanical behavior of CBT screws in vivo by measuring insertional torque 24) . The mean maximum insertional torque of CBT screws (5.5-mm diameter and 30-to 35-mm length) was 71% higher than that of TT screws (6.5-to 7.5-mm diameter and 40-mm length).…”

Section: Fixation Strength Of Cbt Screwmentioning

confidence: 99%

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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In Vivo Analysis of Insertional Torque During Pedicle Screwing Using Cortical Bone Trajectory Technique

Abstract: 2.

Cited by 203 publications

References 25 publications

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: A technical note

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

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