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Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis.
J Neurosurg Spine. 2018 01; 28(1):57-62.JN

Abstract

OBJECTIVE

The cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation.

METHODS

The study included 22 consecutively treated patients who underwent 2-level PLIF with CBT screw fixation for 2-level DS (CBT group, mean follow-up 39 months) and a historical control group of 20 consecutively treated patients who underwent 2-level PLIF using traditional PS fixation for 2-level DS (PS group, mean follow-up 35 months). Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Bony union was assessed by dynamic plain radiographs and CT images. Surgery-related complications, including symptomatic adjacent-segment disease (ASD), were examined.

RESULTS

The mean operative duration and intraoperative blood loss were 192 minutes and 495 ml in the CBT group and 218 minutes and 612 ml in the PS group, respectively (p < 0.05 and p > 0.05, respectively). The mean JOA score improved significantly from 12.3 points before surgery to 21.1 points (mean recovery rate 54.4%) at the latest follow-up in the CBT group and from 12.8 points before surgery to 20.4 points (mean recovery rate 51.8%) at the latest follow-up in the PS group (p > 0.05). Solid bony union was achieved at 90.9% of segments in the CBT group and 95.0% of segments in the PS group (p > 0.05). Symptomatic ASD developed in 2 patients in the CBT group (9.1%) and 4 patients in the PS group (20.0%, p > 0.05).

CONCLUSIONS

Two-level PLIF with CBT screw fixation for 2-level DS could be less invasive and result in improvement of clinical symptoms equal to those of 2-level PLIF using traditional PS fixation. The incidence of symptomatic ASD and the rate of bony union were lower in the CBT group than in the PS group, although these differences were not significant.

Authors+Show Affiliations

1Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo; and.1Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo; and.2Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.1Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo; and.1Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo; and.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29125430

Citation

Sakaura, Hironobu, et al. "Cortical Bone Trajectory Screw Fixation Versus Traditional Pedicle Screw Fixation for 2-level Posterior Lumbar Interbody Fusion: Comparison of Surgical Outcomes for 2-level Degenerative Lumbar Spondylolisthesis." Journal of Neurosurgery. Spine, vol. 28, no. 1, 2018, pp. 57-62.
Sakaura H, Miwa T, Yamashita T, et al. Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2018;28(1):57-62.
Sakaura, H., Miwa, T., Yamashita, T., Kuroda, Y., & Ohwada, T. (2018). Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. Journal of Neurosurgery. Spine, 28(1), 57-62. https://doi.org/10.3171/2017.5.SPINE161154
Sakaura H, et al. Cortical Bone Trajectory Screw Fixation Versus Traditional Pedicle Screw Fixation for 2-level Posterior Lumbar Interbody Fusion: Comparison of Surgical Outcomes for 2-level Degenerative Lumbar Spondylolisthesis. J Neurosurg Spine. 2018;28(1):57-62. PubMed PMID: 29125430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis. AU - Sakaura,Hironobu, AU - Miwa,Toshitada, AU - Yamashita,Tomoya, AU - Kuroda,Yusuke, AU - Ohwada,Tetsuo, Y1 - 2017/11/10/ PY - 2017/11/11/pubmed PY - 2018/6/21/medline PY - 2017/11/11/entrez KW - 2-level degenerative lumbar spondylolisthesis KW - 2-level posterior lumbar interbody fusion KW - ASD = adjacent-segment disease KW - CBT = cortical bone trajectory KW - DS = degenerative lumbar spondylolisthesis KW - EBL = estimated intraoperative blood loss KW - JOA = Japanese Orthopaedic Association KW - PLIF = posterior lumbar interbody fusion KW - PS = pedicle screw KW - clinical outcome KW - cortical bone trajectory screw technique KW - fusion status KW - traditional pedicle screw technique SP - 57 EP - 62 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 28 IS - 1 N2 - OBJECTIVE The cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation. METHODS The study included 22 consecutively treated patients who underwent 2-level PLIF with CBT screw fixation for 2-level DS (CBT group, mean follow-up 39 months) and a historical control group of 20 consecutively treated patients who underwent 2-level PLIF using traditional PS fixation for 2-level DS (PS group, mean follow-up 35 months). Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Bony union was assessed by dynamic plain radiographs and CT images. Surgery-related complications, including symptomatic adjacent-segment disease (ASD), were examined. RESULTS The mean operative duration and intraoperative blood loss were 192 minutes and 495 ml in the CBT group and 218 minutes and 612 ml in the PS group, respectively (p < 0.05 and p > 0.05, respectively). The mean JOA score improved significantly from 12.3 points before surgery to 21.1 points (mean recovery rate 54.4%) at the latest follow-up in the CBT group and from 12.8 points before surgery to 20.4 points (mean recovery rate 51.8%) at the latest follow-up in the PS group (p > 0.05). Solid bony union was achieved at 90.9% of segments in the CBT group and 95.0% of segments in the PS group (p > 0.05). Symptomatic ASD developed in 2 patients in the CBT group (9.1%) and 4 patients in the PS group (20.0%, p > 0.05). CONCLUSIONS Two-level PLIF with CBT screw fixation for 2-level DS could be less invasive and result in improvement of clinical symptoms equal to those of 2-level PLIF using traditional PS fixation. The incidence of symptomatic ASD and the rate of bony union were lower in the CBT group than in the PS group, although these differences were not significant. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/29125430/Cortical_bone_trajectory_screw_fixation_versus_traditional_pedicle_screw_fixation_for_2_level_posterior_lumbar_interbody_fusion:_comparison_of_surgical_outcomes_for_2_level_degenerative_lumbar_spondylolisthesis_ L2 - https://thejns.org/doi/10.3171/2017.5.SPINE161154 DB - PRIME DP - Unbound Medicine ER -