Evaluating Minimally Invasive Spine Surgery With Midline Cortical Bone Trajectory Screw Fixation for Lumbar Degenerative Disease in a Retrospective Study of 200 Patients

Noh, Sung Hyun; Zhang, Ho Yeol

doi:10.14245/ns.2142016.008

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…No significant complications were observed in any patient during long‐term follow‐up. However, previous studies have identified some CBT screw‐related complications, such as screw fall‐off, pedicle fractures, and pseudo‐joint formation 18 …”

Section: Discussionmentioning

confidence: 99%

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The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Lin

Zheng

2023

Orthopaedic Surgery

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Objective Although cortical bone trajectory (CBT) screw fixation has been used for several years, the number of studies on its fusion effects is limited. Furthermore, several studies report conflicting outcomes. We aimed to compare the fusion rates and clinical efficacy of CBT screw fixation and pedicle screw (PS) fixation for L4‐L5 interbody fusion. Methods This study was a retrospective cohort control study. Patients with lumbar degenerative disease who underwent L4‐L5 oblique lumbar interbody fusion (OLIF) or posterior decompression using CBT screws between February 2016 and February 2019 were included. Patients in whom PS was used were matched for age, sex, height, weight, and BMI. Record the operation time, blood loss. All enrolled patients underwent lumbar CT imaging at one‐year follow‐up to evaluate the fusion rate. At the two‐year follow‐up the visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association scores (JOA) were used to identify symptom improvement. Independent t ‐test was used for the comparison, and score data were analyzed using the χ 2 and exact probability tests. Results A total of 144 patients with were included. All patients were followed‐up postoperatively for 25–36 months (average 32.42 ± 10.55 months). Twenty‐eight patients underwent OLIF and CBT screw fixation, 36 underwent OLIF and PS fixation, 32 underwent posterior decompression and CBT screw fixation, and 48 underwent posterior decompression and PS fixation. The fusion rates following CBT screw and PS fixations in OLIF were 92.86% (26/28) and 91.67% (33/36), respectively ( P = 1). The fusion rates following CBT screw and PS fixations in posterior decompression were 93.75% (30/32) and 93.75% (45/48), respectively ( P > 0.05). Regardless of OLIF or posterior decompression, there were no significant differences in the VAS, ODI, and JOA scores between patients treated with CBT and PS ( P > 0.05). Conclusion CBT screw fixation can achieve a satisfactory interbody fusion rate with a clinical efficacy similar to that of PS in patients with lumbar degenerative disease, regardless of whether OLIF or posterior decompression was performed.

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Section: Discussionmentioning

confidence: 99%

“…However, previous studies have identified some CBT screw‐related complications, such as screw fall‐off, pedicle fractures, and pseudo‐joint formation. 18 …”

Section: Discussionmentioning

confidence: 99%

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Lin

Zheng

2023

Orthopaedic Surgery

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“…Меньшие длительность операции, объем кровопотери и мышечной травмы при процедуре MIDLIF способствуют быстрой активизации пациентов, что особенно важно при остеопорозе. При более длительном наблюдении (в течение трех лет) после поясничного спондилодеза с MIDLIF у пациентов с остеопорозом общая частота стабильного костного блока достигает 90,5 % и значимо улучшается качество жизни [26] дом предотвращения расшатывания и инструментальных осложнений [27]. В неконтролируемых ретро-и проспективных исследованиях использование ПММА с канюлированными винтами у пациентов с остеопорозом для выполнения транспедикулярной фиксации в сочетании с заднелатеральным или межтеловым спондилодезом практически исключает вероятность расшатывания винтов и в подавляющем большинстве случаев значимо улучшает клинические исходы [28][29][30][31][32].…”

Section: результатыunclassified

Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review

Shirokikh,

Vasilyev,

Batrak

et al. 2024

Hir. pozvonoč.

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Objective. To analyze methods contributing to the improvement of clinical and radiological outcomes of surgical stabilization of the lumbar spine in conditions of reduced bone mineral density (BMD).Material and Methods. A search for publications presenting the results of clinical studies of surgical treatment of patients with degenerative lesions of the lumbar spine and reduced BMD was conducted in English and Russian in the MEDLINE and Russian Science Citation Index (RSCI) databases using key words “osteoporosis”, “osteopenia”, “spinal surgery”, “spinal fusion” and related terms in titles and abstracts with a search depth of 20 years. After applying the inclusion and exclusion criteria, 17 clinical studies were selected for analysis.Results. Among the large number of techniques and implant-associated factors affecting the success of surgical intervention for degenerative lesions of the lumbar spine and reduced BMD, high-quality clinical studies have proven the effectiveness of expandable screws, spinal fusion with cortical screw placement and cement augmentation with polymethyl methacrylate.Conclusion. The combination of techniques for cortical pedicle screw placement, cement augmentation and the use of expandable screws makes it possible to achieve results in surgical treatment of patients with degenerative lesions of the lumbar spine with reduced BMD comparable with those in patients with normal BMD. Of particular importance is the preoperative assessment of the regional state of bone tissue, which should be carried out using quantitative CT or MRI studies.

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“…The adaption of CBT has demonstrated feasibility and effectiveness in short-segment lumbar fusion surgery. 25,[27][28][29] According to biomechanical studies, the CBT had up to a 30% increase of pullout strength compared to the conventional pedicle trajectory. 26,30 Since CBT potentially improves bone-to-screw osteointegration and reinforces the screw purchase to decrease screw loosening or breakage, it might be a reasonable innovation to adapt CBT for DS in the management of lumbar instability.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients

Chang

et al. 2023

Neurospine

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Objective: Pedicle-based dynamic stabilization (DS) has gained popularity outside of America. Although pedicle screw (PS) loosening has always been a concern, it is reportedly innocuous. Cortical bone trajectory (CBT) screw is an emerging option with less invasiveness and similar effectiveness to PS in short-segment lumbar fusion. This study aimed to verify the use of CBT for DS by comparing the outcomes between pedicle- and CBT-based DS.Methods: Consecutive patients with lumbar spondylosis or low-grade spondylolisthesis who underwent 1- or 2-level DS between L3–5 with a minimum follow-up of 24 months were reviewed. Screw loosening was determined by computed tomography and the incidences were compared.Results: A total of 291 patients who underwent Dynesys DS (235 pedicle- and 56 CBT-based, respectively) were compared. The demographics and preoperative conditions were similar. All the clinical outcomes improved at 24-month postoperation, while the CBT-based group had less operation time and blood loss than the pedicle-based group. The rates of screw loosening were lower in the CBT-based (5.4% per screw and 12.5% per patient) than the pedicle-based group (9% per screw and 26.4% per patient). Furthermore, there were no differences in the clinical outcomes and complication profiles.Conclusion: The CBT-based DS for 1- or 2-level lumbar degeneration demonstrated equivalent clinical improvement as the pedicle-based DS. The adaption of CBT-based screws for DS could be a less invasive approach (shorter operation time and less blood loss), with lower chances of screw loosening than the conventional PS-based DS.

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Evaluating Minimally Invasive Spine Surgery With Midline Cortical Bone Trajectory Screw Fixation for Lumbar Degenerative Disease in a Retrospective Study of 200 Patients

Cited by 7 publications

References 19 publications

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study

Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review

Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients

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