One-Year Prospective Evaluation of the Technique of Percutaneous Cortical Bone Trajectory Spondylodesis in Comparison with Percutaneous Pedicle Screw Fixation: A Preliminary Report with Technical Note

Abstract

Background and Objective Cortical bone trajectory (CBT) spondylodesis is a novel screw fixation method in which screws are inserted through the pedicle in a caudal-medial to cephalad-lateral direction, providing a similar or more rigid spinal fixation compared with traditional pedicle screws. However, the traditional CBT technique requires invasive detaching and opening of the paraspinal muscle. In a small clinical prospective study we introduced a percutaneous CBT fixation technique by modifying the percutaneous pedicle screw (PPS) technique and evaluated the short-term outcome.

Materials and Methods We enrolled 40 patients with lower back pain (LBP) and limb r;adicular pain with a diagnosis of spondylolisthesis who underwent transforaminal lumbar interbody fusion surgery. The patients were divided into two groups according to screw trajectory: the percutaneous CBT (pCBT) and the traditional PPS arms (20 patients in each). A consecutive group of 20 patients underwent traditional PPS, and the other underwent pCBT; dorsal spondylodesis was combined with transforaminal lumbar interbody fusion (TLIF) in both groups. Perioperative data such as operative time, blood loss, duration of fluoroscopy, and total incision length were investigated. Postoperative outcomes were evaluated using the visual analog scale (VAS) for LBP and leg pain at baseline, 1, 6, and 12 months. A p value < 0.05 was considered statistically significant.

Results We observed no significant disadvantages in pCBT patients in perioperative and postoperative data compared with the PPS group. There were no complications. The pCBT patients showed a significantly shorter total incision length (p < 0.01) with a significantly shorter duration of fluoroscopy (p < 0.05). The postoperative VAS score was significantly improved in the pCBT group, especially 6 months after the surgery (p < 0.05).

Conclusion The pCBT spondylodesis provided an outcome comparable with PPS fixation with a tendency for improvement 1 year postsurgery. This technique can be used in appropriate cases, combined with lumbar interbody fusion.

Keywords

cortical bone trajectory (CBT) - minimally invasive surgery - percutaneous fixation - transforaminal lumbar interbody fusion (TLIF)

• References

• 1 Santoni BG, Hynes RA, McGilvray KC , et al. Cortical bone trajectory for lumbar pedicle screws. Spine J 2009; 9 (5) 366-373
• 2 Matsukawa K, Yato Y, Kato T, Imabayashi H, Asazuma T, Nemoto K. In vivo analysis of insertional torque during pedicle screwing using cortical bone trajectory technique. Spine 2014; 39 (4) E240-E245
• 3 Mizuno M, Kuraishi K, Umeda Y, Sano T, Tsuji M, Suzuki H. Midline lumbar fusion with cortical bone trajectory screw. Neurol Med Chir (Tokyo) 2014; 54 (9) 716-721
• 4 Waschke A, Hartmann C, Walter J , et al. Denervation and atrophy of paraspinal muscles after open lumbar interbody fusion is associated with clinical outcome—electromyographic and CT-volumetric investigation of 30 patients. Acta Neurochir (Wien) 2014; 156 (2) 235-244
• 5 Steel TR, Rust TM, Fairhall JM, Mobbs RJ. Monosegmental pedicle screw fixation for thoraco-lumbar burst fracture. J Bone Joint Surg Br 2004; 86-B (SUPP IV): 458
• 6 Harris EB, Massey P, Lawrence J, Rihn J, Vaccaro A, Anderson DG. Percutaneous techniques for minimally invasive posterior lumbar fusion. Neurosurg Focus 2008; 25 (2) E12
• 7 Anderson DG, Samartzis D, Shen FH, Tannoury C. Percutaneous instrumentation of the thoracic and lumbar spine. Orthop Clin North Am 2007; 38 (3) 401-408 ; abstract vii
• 8 Matsukawa K, Yato Y, Nemoto O, Imabayashi H, Asazuma T, Nemoto K. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech 2013; 26 (6) E248-E253
• 9 Dhall SS, Wang MY, Mummaneni PV. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. J Neurosurg Spine 2008; 9 (6) 560-565
• 10 Blair-Pattison A, Hu RW, Swamy G, Anglin C. Forces in spinal cannulation and breaches ex vivo. Proc Inst Mech Eng H 2014; 228 (7) 693-702