Minimally Invasive Surgery Combining Cortical Bone Trajectory Screws and Pedicle Screws to Treat Spondylodiskitis: Technical Notes and Preliminary Results

Chiu, Ping-Yeh; Chi, Jia-En; Kao, Fu-Cheng; Hsieh, Ming-Kai; Tsai, Tsung‐Ting

doi:10.1016/j.wneu.2019.11.165

Cited by 4 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Takata et al [ 18 ] first proposed a hybrid CBT-TT technique and applied it to patients with degenerative spondylolisthesis, which could reduce the peeling of soft tissue and the incision length. Chiu et al [ 19 ] demonstrated that the mean Numeric Rating Scale and Oswestry Disability Index scores were significantly improved, the damaged anterior column could be debrided and reconstructed, and spinal stabilization could be achieved when applying the hybrid CBT-TT technique in patients with spondylodiskitis. In addition to CBT-TT, we proposed the hybrid TT-CBT technique for patients with lumbar spondylolisthesis.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Kahaer

Zhou

Maitirouzi

et al. 2022

Journal of Healthcare Engineering

View full text Add to dashboard Cite

There is no detailed biomechanical research about the hybrid CBT-TT (CBT screws at cranial level and TT screws at caudal level) and TT-CBT (TT screws at cranial level and CBT screws at caudal level) techniques with finite element (FE) method. Therefore, the purpose of this study was to evaluate and provide specific biomechanical data of the hybrid lumbar posterior fixation system and compare with traditional pedicle screw and cortical screw trajectories without fusion, in FE method. Specimens were from the anatomy laboratory of Xinjiang Medical University. Four FE models of the L4-L5 lumbar spine segment were generated. For each of these, four implanted models with the following instruments were created: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT fixation, and hybrid TT-CBT fixation. A 400 N compressive load with 7.5 Nm moments was applied so as to simulate flexion, extension, left lateral bending, right lateral bending, left rotation, and right rotation, respectively. The range of motion (ROM) of the L4-L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation in four implanted models were compared. CBT-TT displayed a lower ROM of the fixation segment (3.82 ± 0.633°) compared to TT-TT (4.78 ± 0.306°) and CBT-CBT (4.23 ± 0.396°). In addition, CBT-TT showed a lower ROM of the posterior fixation (0.595 ± 0.108°) compared to TT-TT (0.795 ± 0.103°) and CBT-CBT (0.758 ± 0.052°). The intervertebral disc stress of CBT-TT (4.435 ± 0.604 MPa) was lower than TT-TT (7.592 ± 0.387 MPa) and CBT-CBT (6.605 ± 0.600 MPa). CBT-TT (20.228 ± 3.044 MPa) and TT-CBT (12.548 ± 2.914 MPa) displayed a lower peak von Mises stress of the posterior fixation compared to TT-TT (25.480 ± 3.737 MPa). The hybrid CBT-TT and TT-CBT techniques offered superior fixation strength compared to the CBT-CBT and TT-TT techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Kahaer

Zhou

Maitirouzi

et al. 2022

Journal of Healthcare Engineering

View full text Add to dashboard Cite

show abstract

“…This procedure has shown good clinical application with complete decompression, short operative time, low bleeding, little damage to the spine, quick postoperative recovery, low complication rate, and preservation of most of the posterior vertebral column structures [ 39 , 40 ]. However, compared to the TT–TT and CBT–CBT techniques, biomechanical analysis of the stress profile of fused segments in TLIF with hybrid CBT–TT and TT–CBT fixation techniques has been less reported in the literature, mostly as solid studies of human anatomical specimens, without the use of FEA [ 19 , 31 ]. In this study, the biomechanical performance differences between traditional single or hybrid lumbar fixation techniques in TLIF using the FE model have been further investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have reported the use of a hybrid fixation technique in transforaminal lumbar interbody fusion. This technique allowed for the shortening of the fixation level and achieved spinal stability without invading the adjacent segment [ 19 ]. However, there were still relatively few reports on the biomechanical properties of the hybrid fixation technique.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis

Huang,

Maimaiti,

Tian

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

Objective To compare the biomechanical performance of the hybrid lumbar fixation technique with the traditional and cortical bone trajectory techniques using the finite element method. Methods Four adult wet lumbar spine specimens were provided by the Department of Anatomy and Research of Xinjiang Medical University, and four L1–S1 lumbar spine with transforaminal lumbar interbody fusion (TLIF) models at L4–L5 segment and four different fixation techniques were established: bilateral traditional trajectory screw fixation (TT–TT), bilateral cortical bone trajectory screw fixation (CBT–CBT), hybrid CBT–TT (CBT screws at L4 and TT screws at L5) and TT–CBT (TT screws at L4 and CBT screws at L5). The range of motion (ROM) of the L4–L5 segment, von Mises stress of cage, internal fixation, and rod were compared in flexion, extension, left and right bending, and left and right rotation. Results Compared with the TT–TT group, the TT–CBT group exhibited lower ROM of L4–L5 segment, especially in left-sided bending; the CBT–TT group had the lowest ROM of L4–L5 segment in flexion and extension among the four fixation methods. Compared with the CBT–CBT group, the peak cage stress in the TT–CBT group was reduced by 9.9%, 18.1%, 21.5%, 23.3%, and 26.1% in flexion, left bending, right bending, left rotation, and right rotation conditions, respectively, but not statistically significant (P > 0.05). The peak stress of the internal fixation system in the TT–CBT group was significantly lower than the other three fixation methods in all five conditions except for extension, with a statistically significant difference between the CBT–TT and TT–CBT groups in the left rotation condition (P = 0.017). In addition, compared with the CBT–CBT group, the peak stress of the rod in the CBT–TT group decreased by 34.8%, 32.1%, 28.2%, 29.3%, and 43.0% under the six working conditions of flexion, extension, left bending, left rotation, and right rotation, respectively, but not statistically significant (P > 0.05). Conclusions Compared with the TT–TT and CBT–CBT fixation methods in TLIF, the hybrid lumbar fixation CBT–TT and TT–CBT techniques increase the biomechanical stability of the internal fixation structure of the lumbar fusion segment to a certain extent and provide a corresponding theoretical basis for further development in the clinic.

show abstract

“…However, it should be noted that it has been reported that during the process of robotic screw placement, adjusting the scanning eld of view may cause visual distortion, thereby causing positioning errors [45]. The studies by Marengo et al [46] and Lee et al [47] comparatively analyzed the clinical e cacy and safety of CBT and PS and found that CBT can better protect the facet joints. Therefore, during surgery, when the doctor's subjective judgment con icts with the robot's screw placement, he cannot rely entirely on the robot.…”

Section: Screw Placement Accuracy Facet Joint Invasion Rate and Numbe...mentioning

confidence: 99%

Research on the anatomical application of robot and 3D guide-assisted lumbar cortical bone trajectory screw placement technique

Maimaiti,

Xiao,

Zhang

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: To compare the accuracy of robotic and 3D guide-assisted cortical bone trajectory (CBT) screw placement in lumbar spine in human cadaver wet specimens. Methods:Six lumbar cadaver specimens were included. The left and right sides of L1-L5 vertebrae were randomly selected for screw placement using two techniques. Evaluation of preoperative planning time, intraoperative injury level and postoperative screw placement accuracy, number of cortical bone contact layers, and facet joint invasion rate were performed for two surgical techniques. Results: A total of 60 screws were implanted. The accuracy of robot-assisted screw placement with 93% were significantly higher than 3D guide-assisted screw placement with 97% (15 screws with level 0, 13 screws with level 1, and 2 screws with level 2). The average number of cortical bone contact layers on the robot-assisted and 3D guide-assisted screw placement side were 4.6 and 4.1 (P<0.05). Four screws on the robot-assisted side were grade 2, and the remaining 26 screws were grade 0. The facet joints invasion rate was 13.3%. Two screws on the 3D guide-assisted side were grade 2, and the remaining 28 screws were grade 0, facet joints invasion rate was 6.7%. There was no statistical difference in facet joint invasion rate between the two screw placement methods (P>0.05). Conclusion:Robot-assisted screw placement is more accurate, safe, and minimally invasive than 3D guide plate-assisted screw placement. It has advantages over 3D guide plate-assisted screw placement in terms of cortical bone contact, and can further increase the screw-holding force.

show abstract

Minimally Invasive Surgery Combining Cortical Bone Trajectory Screws and Pedicle Screws to Treat Spondylodiskitis: Technical Notes and Preliminary Results

Cited by 4 publications

References 34 publications

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis

Research on the anatomical application of robot and 3D guide-assisted lumbar cortical bone trajectory screw placement technique

Contact Info

Product

Resources

About