Cortical bone trajectory technique's outcomes and procedures for posterior lumbar fusion: A retrospective study. (June 2020)

• Record Type: Journal Article
• Authors: Petrone, Salvatore; Marengo, Nicola; Ajello, Marco; Lavorato, Andrea; Penner, Federica; Cofano, Fabio; Zenga, Francesco; Garbossa, Diego
• Is Part Of: Journal of clinical neuroscience. Volume 76(2020)
• Page Start: 25
• Page End: 30
• Publication Date: 2020-06
• Subjects: Cortical bone trajectory -- Cortical pedicle screws -- Posterior lumbar fusion -- Minimally invasive surgery -- Planning -- 3D printed guide; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.04.070
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: CBT screws need a limited soft tissue dissection with mechanical properties comparable to traditional pedicle screws. The Cortical Bone Trajectory represents a more demanding procedure associated with an acceptable rate of complication. Preoperative CT scan: planning the maximum length and size of the screw. Identify unfavorable anatomical conditions. The highest screw positioning accuracy is reached with a 3D patient-tailored template guide. Abstract: Cortical Bone Trajectory screws allow a limited soft tissue dissection with mechanical properties comparable to traditional pedicle screws. However, clinical results are still reported on limited samples. The study aimed to evaluate perioperative and mid-term follow up outcomes, clinical results and complications in 238 consecutive patients underwent CBT fusion for degenerative lumbosacral disease. Pre- and intraoperative data, clinical outcomes and complications were collected. The patients were stratified in three groups. The original technique was performed in the first 43 cases without a preoperative CT scan planning. The second group includes the patients who underwent preoperative CT scan for entry point and screw trajectory planning (158 patients). Surgical procedures in the last group were performed with patient-matched 3D printed guide (37 patients). The accuracy in screws positioning was evaluated on postoperative CT scan. The mean follow-up was 32.3 months. Mean ODI and VAS index improved with statistical significance. Mean procedural time was 187, 142 and 124 min in the three subgroups. The total amount of recorded complications was 4.2% (16.3%, 3.8% and 0.0% respectively). Screws entirely within the cortex of the pedicle were 78.9%, 90.5% and 93.9% in the three groups. Fusion was obtained in 92.4% of cases. The CBT technique is a safe procedure, especially with an accurate preoperative CT scan-based planning. This seems more evident with the 3D template patient-matched guide. More studies are needed to directly compare traditional pedicle screws and CBT screws on long-term outcomes.