Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon's Experience With 3-Year Follow-up

Arzoglou, Vasileios; Vial, Izziddine; Hussain, Masood; Deepak, Srihari; Andalib, Amin; Storey, Matthew; Graham, Christopher; Tsitlakidis, Abraham

doi:10.1227/ons.0000000000000042

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…This step is the key differentiating point compared with previous descriptions of other authors' novel approaches whereby low-profile cages are passed end-on having been preassembled using small endcaps whose sizes are limited by the aforementioned mismatch in insertion corridor and endplate surface area. 18 - 20 A schematic representation of our full technique can be found in Figure 1 . A Video shows an L2 corpectomy.…”

Section: Methodsmentioning

confidence: 99%

Novel Nerve-Sparing In Situ Assembly of an Expandable Titanium Cage to Maximize Endplate Coverage After Posterior Corpectomy for Comminuted Lumbar Burst Fractures

Felton,

John,

Daneshfar

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: The ability to maximize corpectomy cage endcap size and vertebral endplate coverage after corpectomy for lumbar burst fractures (L1-L5) is limited by the presence of lumbar nerve roots and the larger cross-sectional area of the lumbar endplates relative to the restrictive corridor for cage insertion. This work aims to provide details and clinical examples of a novel operative technique for 3-column reconstruction and stabilization of comminuted lumbar burst fractures. METHODS: Through a standard posterior midline approach and following posterior instrumentation and lateral extracavitary corpectomy, an in-situ assembly of a modular corpectomy cage that respects adjacent neural structures, restores segmental alignment, and maximizes endplate coverage across a lordotic segment is completed. RESULTS: Radiographic evidence of anatomic spinal reconstruction and stabilization with complete or near-complete endplate coverage without incurrence of new clinical deficit after this novel treatment of lumbar burst fractures. CONCLUSION: The fixation approach described in this report may be a valuable modification to a long-standing technique used for treating comminuted lumbar burst fractures (L1-L5) from a posterior-only approach without incurring additional neurological deficits and by improving endplate and apophyseal ring coverage.

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Section: Methodsmentioning

confidence: 99%

Novel Nerve-Sparing In Situ Assembly of an Expandable Titanium Cage to Maximize Endplate Coverage After Posterior Corpectomy for Comminuted Lumbar Burst Fractures

Felton,

John,

Daneshfar

et al. 2023

Operative Neurosurgery

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“…In 2009, Santoni et al proposed the cortical bone trajectory (CBT), which was designed to increase the contact between the screw and the cortical bone by changing the screw path and improving the stability [ 4 , 5 ]. Recent studies have found that the CBT is more effective than the TT in improving mechanical stability, less intraoperative bleeding, shorter hospital stay, less intrusion of adjacent joints, and less paravertebral muscle damage, Based on these advantages, the CBT technique is no longer limited to osteoporotic patients and has been applied to bariatric patients and revision surgery [ 3 , 6 ]. Authors found that the CBT technique still has shortcomings, the screw track does not utilize the medial and inferior wall of the pedicle and the bone cortex of the lateral edge of the upper endplate, the screw may damage the facet joint and the adjacent intervertebral disc, the screw entry point and the lateral wall of the pedicle were prone to rupture, and the screw entry point lacks reliable anatomical reference structures.…”

Section: Introductionmentioning

confidence: 99%

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

et al. 2022

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Background To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. Methods CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20–30 years old group and 20 male and 20 female cases in the 30–40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. Results The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). Conclusions According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.

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“…These advantages include smaller incisions and faster operating times, with patient outcomes equivalent to standard pedicle screw use. 1 The prospective study by Arzoglou et al 2 describes 3 years of follow-up for patients who underwent lumbar fixation with CBT screws. Eighty patients with grade 1 spondylolisthesis underwent lumbar fixation by 1 surgeon.…”

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confidence: 99%

“…Similarly, Wangsawatwong et al 21 demonstrated that cortical screw-rod fixation had different effects on adjacent segment mobility than pedicle screw-rod fixation. Arzoglou et al 2 described 4 patients with adjacent segment disease, 2 of which underwent surgery within 3 years of the index surgery. Future studies are warranted to determine the ideal indications and patient groups suited for CBT fixation and the effects of CBT fixation on adjacent segment disease, radiologic outcomes, and patient-related quality-of-life outcomes.…”

mentioning

confidence: 99%

Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-up

Katsevman

Morgan

Uribe

2022

Operative Neurosurgery

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umbar fixation using cortical bone trajectory (CBT) is increasingly popular among spine surgeons. Although some surgeons argue that the trajectory is technically demanding or requires further studies, various advantages are reported. These advantages include smaller incisions and faster operating times, with patient outcomes equivalent to standard pedicle screw use. 1 The prospective study by Arzoglou et al 2 describes 3 years of follow-up for patients who underwent lumbar fixation with CBT screws. Eighty patients with grade 1 spondylolisthesis underwent lumbar fixation by 1 surgeon. Outcomes were measured at 1 and 3 years postoperatively, including Oswestry Disability Index, Visual Analog Scale (back and leg) pain, walking distance, opioid use, and quality-of-life status. All outcome measures had improved by 1 year and remained improved at 3 years compared with preoperative scores.The authors classified patients into 4 groups for analysis: (1) microinstability (facet joint effusion >1.5 mm) but no spondylolisthesis, (2) microinstability with spondylolisthesis, (3) severe foraminal narrowing requiring facetectomy and impending iatrogenic instability regardless of spondylolisthesis, and (4) dynamic instability with spondylolisthesis. The groups had different rates of improvement over time, with some, but not all, continuing to improve between years 1 and 3. Patients in groups 3 and 4 and those with high body mass index sustained postoperative improvement longer than 1 year. This study adds to the body of literature that demonstrates CBT screws are a reasonable alternative to standard pedicle screws in certain patients.Lee et al 3 performed a prospective, randomized trial comparing pedicle and cortical screws in lumbar interbody fusion. CBT screws provided comparable clinical and radiographic outcomes, demonstrating noninferiority. Various reviews have similarly shown equivalent and, at times, superior clinical outcomes for CBT screw fixation compared with traditional pedicle screw fixation. Phan et al 4 reviewed 9 studies and revealed

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Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon's Experience With 3-Year Follow-up

Cited by 5 publications

References 6 publications

Novel Nerve-Sparing In Situ Assembly of an Expandable Titanium Cage to Maximize Endplate Coverage After Posterior Corpectomy for Comminuted Lumbar Burst Fractures

Novel Nerve-Sparing In Situ Assembly of an Expandable Titanium Cage to Maximize Endplate Coverage After Posterior Corpectomy for Comminuted Lumbar Burst Fractures

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory

Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-up

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