Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Matsukawa, Keitaro; Kato, Takashi; Yato, Yoshiyuki; Sasao, Hiroshi; Imabayashi, Hideaki; Hosogane, Naobumi; Asazuma, Takashi; Chiba, Kazuhiro

doi:10.1097/brs.0000000000001459

Cited by 71 publications

(79 citation statements)

References 20 publications

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“…5 Santoni et al 5 proposed a shorter and slimmer screw design whose specific trajectory allowed maximization of contact with the cortical bone. It has been demonstrated that CBT exerts a lower likelihood of violating the facet joint 6 , and superior pull-out strength than the TT screws, especially in osteoporotic vertebral body. [5][6][7][8][9] Additionally, due to its diverging trajectory, CBT results in minimal surgical wound and multifidus muscle destruction.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Liu

Wang

et al. 2019

Preprint

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Background To evaluate kinetic and kinematic behavior in both static and dynamic CBT fixation a finite element study was designed. Two types of screw trajectories are commonly used in lumbar surgery. Both traditional trajectory (TT) and cortical bone trajectory (CBT) provide equivalent pull-out strengths of a screw. Dynesys fixation of TT screws, but not dynamization of CBT screws, has been used extensively in lumbar surgery. This study aimed to simulate the biomechanics of CBT-based dynamic system for an evaluation of CBT dynamization.Methods A validated nonlinearly lumbosacral finite-element model was used to simulate four variations of screw fixation. Responses of both implant (screw stress) and tissues (disc motion, disc stress, and facet force) at the upper adjacent (L3-L4) and fixed (L4-L5) segments were used as the evaluation indices. Flexion, extension, bending, and rotation of both TT and CBT screws were simulated in this study for comparison.Results The results showed that the TT static was the most effective stabilizer to the L4-L5 segment, followed by CBT static, TT dynamic, and the CBT dynamic, which was the least effective. Dynamization of the TT and CBT fixators decreased stability of the fixed segment and alleviate adjacent segment stress compensation. The 3.5-mm diameter CBT screw deteriorated stress distribution and rendered it vulnerable to bone-screw loosening and fatigue cracking.Conclusions A systematic analysis of the effects of TT and CBT fixation constructs on kinematic and kinetic responses in a full lumbosacral model is currently lacking. This study examined both the static fixation effect and its dynamic counterpart and identified that dynamization of CBT have slightly inferior structural stiffness than dynamic TT and cautious preoperative evaluation is essential if 3.5-mm diameter CBT screws are used. Therefore, 4.5-mm or 5.5-mm diameter CBT screws, or as big as tolerated, are recommended to avoid loosening and cracking.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Liu

Wang

et al. 2019

Preprint

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“…These points correspond to a 5 or 7 o'clock orientation in the pedicle. Since the spur formation and hypertrophy of the cranial facet joint can overhang to the pars interarticularis in cases with severe facet degeneration, selection of lower entry point, as much as possible, is desirable to avoid damage to the adjacent mobile segment 11) . Following this, the screw paths are made under true lateral fluoroscopic guidance to be directed 25-30°cranially along the inferior border of the pedicle toward the posterior third to posterior half of the superior endplate, using the burr and a straight probe (Fig.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…7). The starting point is at the laminar slope as it inclines cranially; thus, surgeons should prevent slippage toward the cranial side during the procedure, which may induce unintentional cranial facet joint violation by the screws 11) . Because the starting points are located around the medial border of the pedicle, a lateral angle of 10°is sufficient to avoid the risk of central neural injury.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…The screw length is determined by the measured path length plus 5 mm, because the screw is inserted at a depth not to impinge the screw head on the dorsal lamina in order to avoid both cranial facet joint violation and the "hubbing" phenomenon 11,40,41) . The standard screw size was 5.5 mm in diameter (4.5 mm for the upper lumbar vertebra) and 35-40 mm in length.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Because cortical bone is less affected by the osteoporotic process than cancellous bone, the CBT technique has the possibility to reduce the incidence of screw loosening and subsequent fusion failure in osteoporotic patients. Additionally, screw insertion from a more medial and caudal starting point requires less exposure and minimizes the procedure-related morbidity: 1) it reduces paraspinal muscles dissection and retraction 10) , 2) it lessens iatrogenic injury to the mobile superior facet joint adjacent to the fused segment 11) , and 3) it maintains neurovascular supply to the fused segment, such as the posteromedial branch of the nerve root passing near the mammillary process 12) . The purpose of this study was to review the anatomical and biomechanical characteristics of CBT and to describe its clinical application, including indications, limitations, surgical techniques, and clinical evidence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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Accuracy of cortical bone trajectory screw fixation guided by spinous process clamp guide in lumbosacral vertebrae: A cadaver study

Zhang

Liu

et al. 2022

Robotics Computer Surgery

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Background The purpose of this study was to access the accuracy of cortical bone trajectory screw placement guided by spinous process clamp (SPC). Methods Eight formalin‐treated cadaveric lumbar specimens with T12‐S1 were used. A total of 96 screws were implanted in eight lumbar specimens. Results In the freehand (FH) group, clinically acceptable placement (grade A and B) was 40 screws (83.3%), meanwhile 44 screws (91.7%) in the SPC guide group (p = 0.217). The grade A screws in the SPC guide group were much more than that in the FH group (n = 40 vs. n = 31, p = 0.036). The misplacement screws (grade C, D, and E) and proximal facet joint violation (FJV) in the SPC group was comparable to the FH group. Conclusions This cadaveric study demonstrate that implanting CBT screws guided by SPC guide was more accuracy and reduces severe deviations in important directions.

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Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Abstract: 3.

Cited by 71 publications

References 20 publications

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

Biomechanical Investigation about Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation

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

Accuracy of cortical bone trajectory screw fixation guided by spinous process clamp guide in lumbosacral vertebrae: A cadaver study

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