Cortical bone trajectory screws for circumferential arthrodesis in lumbar degenerative spine: clinical and radiological outcomes of 101 cases
The use of cortical bone trajectory (CBT) pedicle screws for circumferential interbody fusion represents a viable alternative for single-level procedure with reduced invasiveness and less tissue destruction than the traditional technique. In addition, CBT screws have a potentially stronger pullout strength because of the greater amount of cortical bone intercepted. Only few series exist evaluating clinical and radiological outcomes of CBT screws.
This is a retrospective cohort study. All patients that underwent circumferential lumbar interbody fusion with CBT screws in our institution from 2014 to 2017 were reviewed. Patient demographics, clinical outcome with visual analogue scale (VAS) and Oswestry Disability Index (ODI), radiological data such as fusion, lordosis and muscle trauma, operative blood loss, hospital stay and use of fluoroscopy were evaluated.
A total of 101 patients undergoing CBT-arthrodesis for degenerative lumbo-sacral disease were reviewed. Mean procedural time was 187 min. The mean operative blood loss and X-ray dose per procedure was 383 ml and 1.60 mg cm2, respectively. The mean hospital stay was 3.47 days. The mean follow-up was 18.23 months. Mean lordosis increment at the treated level was 4.2°. When the follow-up was longer than 12 months (53% of patients), fusion was obtained in 94% of cases. Mean ODI and VAS index improved with statistical significance.
This is to our knowledge that the largest available study regarding CBT for circumferential arthrodesis. Results underlined the safety of this technique and the promising clinical and radiological outcomes that will need a longer follow-up.
KeywordsCortical bone trajectory Cortical pedicle screws Cortical screws Lumbar interbody fusion Spinal fusion Spinal fixation
Conflict of interest
PB Honorarium for surgeon's education: Nuvasive, Medacta, Depuy Synthes. Grants for research: Nuvasive, Medacta, Depuy Synthes, K2M. No conflicts of interest were declared by the other authors.
- 1.Snyder LA, Martinez-Del-Campo E, Neal MT et al (2016) Lumbar spinal fixation with cortical bone trajectory pedicle screws in 79 patients with degenerative disease: perioperative outcomes and complications. World Neurosurg 88:205–213. https://doi.org/10.1016/j.wneu.2015.12.065 CrossRefPubMedGoogle Scholar
- 3.Gautschi OP, Garbossa D, Tessitore E et al (2017) Maximal access surgery for posterior lumbar interbody fusion with divergent, cortical bone trajectory pedicle screws: a good option to minimize spine access and maximize the field for nerve decompression. J Neurosurg Sci 61:335–341. https://doi.org/10.23736/S0390-5616.16.03230-6 PubMedGoogle Scholar
- 6.Marengo N, Ajello M, Pecoraro MF et al (2018) 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. BioMed Res Int. https://doi.org/10.1155/2018/7424568 Google Scholar
- 12.Matsukawa K, Yato Y, Imabayashi H et al (2016) Biomechanical evaluation of fixation strength among different sizes of pedicle screws using the cortical bone trajectory: what is the ideal screw size for optimal fixation? Acta Neurochir (Wien) 158:465–471. https://doi.org/10.1007/s00701-016-2705-8 CrossRefGoogle Scholar
- 23.Matsukawa K, Yato Y, Imabayashi H et al (2016) Biomechanical evaluation of lumbar pedicle screws in spondylolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory. J Neurosurg Spine 24:910–915. https://doi.org/10.3171/2015.11.SPINE15926 CrossRefPubMedGoogle Scholar
- 25.Than KD, Mummaneni PV, Bridges KJ et al (2017) Complication rates associated with open versus percutaneous pedicle screw instrumentation among patients undergoing minimally invasive interbody fusion for adult spinal deformity. Neurosurg Focus 43:E7. https://doi.org/10.3171/2017.8.FOCUS17479 CrossRefPubMedGoogle Scholar
- 27.Sakaura H, Miwa T, Yamashita T et al (2017) Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine 1–6. https://doi.org/10.3171/2017.5.spine161154
- 30.Mobbs RJ, Phan K, Malham G et al (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg (Hong Kong) 1:2–18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05 Google Scholar