Cortical screws used to rescue failed lumbar pedicle screw construct: a biomechanical analysis

Calvert, Graham; Lawrence, Brandon D.; Abtahi, Amir M.; Bachus, Kent N.; Brodke, Darrel S.

doi:10.3171/2014.10.spine14371

Cited by 77 publications

(64 citation statements)

References 32 publications

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“…Multiple biomechanical studies have shown equivalence or superiority of the cortical bone trajectory compared to the standard technique for pedicle screw fixation [2-3, 5-10]. Most studies show that cortical screws traverse denser cortical bone and, thus, result in increased pullout strength and improved rigidity.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Lumbar Pedicle Screw Fixation Using Cortical Bone Trajectory – A Prospective Cohort Study on Postoperative Pain Outcomes

Chen

Deb

Pham

et al. 2016

Cureus

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Objective: Our study aims to evaluate the clinical outcomes of cortical screws in regards to postoperative pain.Background: Pedicle screw fixation is the current mainstay technique for posterior spinal fusion. Over the past decade, a new technique called cortical screw fixation has been developed, which allows for medialized screw placement through stronger cortical bone. There have been several studies that showed either biomechanical equivalence or superiority of cortical screws. However, there is currently only a single study in the literature looking at clinical outcomes of cortical screw fixation in patients who have had no prior spine surgery.Methods: We prospectively looked at the senior author’s patients who underwent cortical versus pedicle lumbar screw fixation surgeries between 2013 and 2015 for lumbar degenerative disease. Eighteen patients underwent cortical screw fixation, and 15 patients underwent traditional pedicle screw fixation. We looked at immediate postoperative pain, changes in short-term pain (six to 12 weeks post-surgery), and changes in long-term pain (six to eight months). All pain outcomes were measured using a visual analog scale ranging from 1 to 10. Mann-Whitney or Kruskal-Wallis tests were used to measure continuous data, and the Fisher Exact test was used to measure categorical data as appropriate.Results: Our results showed that the cortical screw cohort showed a trend towards having less peak postoperative pain (p = 0.09). The average postoperative pain was similar between the two cohorts (p = 0.93). There was also no difference in pain six to 12 weeks after surgery (p = 0.8). However, at six to eight months, the cortical screw cohort had worse pain compared to the pedicle screw cohort (p = 0.02).Conclusions: The cortical screw patients showed a trend towards less peak pain in the short-term (one to three days post-surgery) and more pain in the long-term (six to eight months post-surgery) compared to pedicle screw patients. Both cohorts had a statistically significant reduction in pain levels compared to preoperative pain. More studies are needed to further evaluate postoperative pain, long-term functional outcomes, and fusion rates in patients who undergo cortical screw fixation.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Lumbar Pedicle Screw Fixation Using Cortical Bone Trajectory – A Prospective Cohort Study on Postoperative Pain Outcomes

Chen

Deb

Pham

et al. 2016

Cureus

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“…Since CBT follows a widely different screw path from the traditional anatomical transpedicular trajectory, it can be an option for a compromised screw path, such as screw misplacement, screw loosening, and pseudoarthrosis. Supporting this, one biomechanical cadaveric study comparing the fixation of CBT and TT screws used for revision at the same pedicle found that CBT and TT screws each retain adequate construct stability 37) . On the other hand, surgeons should note some contraindications.…”

Section: Indications and Limitationsmentioning

confidence: 88%

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 addition, the superiority of a dual fixation system over a single system (cortical or pedicle screw system alone) has not been demonstrated biomechanically. Additionally, cortical screws have been successfully used for previously instrumented pedicles using CT guidance [14,15]. The feasibility of the use of a hybrid system has also been shown in anatomically intact, non-osteoporotic spines.…”

Section: Discussionmentioning

confidence: 99%

The use of a pedicle screw–cortical screw hybrid system for the surgical treatment of a patient with congenital multilevel spinal non-segmentation defect and spinal column deformity: a technical note

et al. 2016

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Cortical screws used to rescue failed lumbar pedicle screw construct: a biomechanical analysis

Cited by 77 publications

References 32 publications

Minimally Invasive Lumbar Pedicle Screw Fixation Using Cortical Bone Trajectory – A Prospective Cohort Study on Postoperative Pain Outcomes

Minimally Invasive Lumbar Pedicle Screw Fixation Using Cortical Bone Trajectory – A Prospective Cohort Study on Postoperative Pain Outcomes

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

The use of a pedicle screw–cortical screw hybrid system for the surgical treatment of a patient with congenital multilevel spinal non-segmentation defect and spinal column deformity: a technical note

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