1
|
Zeng W, Hu S, Zhu Z, Wang S, Guo L, Shi B. A 3D-CT Study of the Cortical Bone Trajectory Screw Placement Parameters Based on Lumbar CT. Orthop Surg 2024. [PMID: 39187426 DOI: 10.1111/os.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE The cortical bone trajectory (CBT) technology is an effective substitute for traditional pedicle screw (PS) technology. However, there is still controversy about the CBT screw technology placement strategy. The objective of this study was to simulate cortical screw placement with the help of three-dimensional (3D) software, to discuss the differences in screws between genders and vertebral segments, and to explore a safer and more efficient strategy for cortical screw placement. METHODS Mimics Medical software was used to construct a 3D model of the lumbar spine, and the placement of CBT screws was simulated. The volume of each vertebral body from L1 to L5, the pedicle isthmus height (IH), the pedicle isthmus width (IW), and the sagittal vertebral distance (SAVD) were measured. The transverse distance (TD) and the longitudinal distance (LD) between the ideal starting point (SP) and the clinical SP (the intersection Q of the midline of the superior articular process and the horizontal line 1 mm below the transverse process) were measured. The cephalad angle (CA), lateral angle (LA), maximum screw diameter (MSD), maximum screw length (MSL) of each trajectory of the L1 to L5 vertebral bodies, and the percentage of the screw insertion depth (PSID) into the vertebral body were measured. Data were statistically analyzed using Student's t-test, one-way analysis of variance (ANOVA), and Tukey's test. RESULTS Vertebral anatomical parameters and CBT screw parameters differed between males and females. Female patients had lower IH, IW, SAVD, CA, LA, MSD, and MSL than males. IH was greatest in L1 (male, 17.81 mm; female, 16.12 mm) and the smallest in L5 (male, 14.11 mm; female, 13.05 mm). IW was smallest in L1 (male, 8.89 mm; female, 7.37 mm) and greatest in L5 (male, 16.59 mm; female, 15.43 mm). The MSD of males was smallest in L1 (6.05 mm) and greatest in L3 (7.06 mm); the MSD of females was smallest in L1 (5.13 mm) and greatest in L4 (6.64 mm). MSL was greatest at L3 (male, 33.63 mm; female, 32.28 mm) and smallest at L5 (male, 31.25 mm; female, 29.97 mm). CA was smallest in L1 (male, 22.80°; female, 21.92°) and greatest in L3 (male, 25.29°; female, 24.33°). LA was smallest in L1 (male 12.37°, female 11.27°) and greatest in L5 (male 13.56°, female 12.96°). Among the males, TD was smallest at L1 (-0.51 mm) and greatest at L5 (1.37 mm), while LD was greatest at L2 (3.46 mm) and smallest at L5 (2.40 mm). In females, TD was greatest at L1 (0.12 mm) and smallest at L3 (-0.51 mm), while LD was greatest at L1 (3.69 mm) and smallest at L5 (2.08 mm). In the overall sample, the incidence of SAVD and PSID gradually increased from L1 to L5. CONCLUSION The optimal screw placement strategy for CBT screws varies significantly according to sex and vertebral body segments, particularly noting the specificity of screw placement at L5. The optimal screw placement strategy should be selected based on the patient's sex and segment characteristics before surgery to maximize the safety and accuracy of CBT screw placement.
Collapse
Affiliation(s)
- Weibo Zeng
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shengxuan Hu
- Department of Orthopedic, Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Zhemin Zhu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shuai Wang
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Lijun Guo
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Benchao Shi
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
2
|
Zhang XN, Su QJ, Pei BQ, Pan AX, Yang HH, Ding HT, Hai Y, Liu YZ. The accuracy of cortical bone trajectory screw placement guided by spinous process clamp hardware in lumbar spinal surgery: a retrospective study. Sci Rep 2023; 13:16447. [PMID: 37777594 PMCID: PMC10542810 DOI: 10.1038/s41598-023-43406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 09/23/2023] [Indexed: 10/02/2023] Open
Abstract
This study aimed to assess the accuracy of cortical bone trajectory (CBT) screws placement guided by a spinous process clamp (SPC) guide. A total of 32 patients who received single-level midline lumbar fusion (MIDLF) surgery between June 2019 and January 2020 were retrospectively analyzed and divided into free-hand (FH) and SPC-guided groups according to the surgical approach. In the FH group, CBT screws was implanted with the assistance of fluoroscopy, while in the SPC group, CBT screws was implanted using the SPC navigator hardwire. A total of 128 screws were assessed in this study, with higher rates of clinically acceptable screw placement (grades A and B) and grade A screws in the SPC group than in the FH guide group (92.2% vs. 79.7%, P = 0.042 and 54.7% vs. 35.9%, P = 0.033, respectively). Misplacement screws (grades C, D, and E) occurred more often in the FH group than in the SPC guide group (20.3% vs. 7.8%, P = 0.042). The incidence of proximal facet joint violation (FJV) was higher in the FH group than in the SPC group (15.6% vs. 3.1%, P = 0.030). The radiation dose and time in the SPC guide group were comparable to those in the FH group (P = 0.063 and P = 0.078). The average operative time was significantly longer in the SPC guide group than in the FH group (267.8 ± 45.5 min vs. 210.9 ± 44.5 min, P = 0.001). Other clinical parameters, such as the average bone mineral density (BMD), intraoperative blood loss, and postoperative hospital stay, were not significantly different. Oswestry disability index (ODI) and back pain visual analogue scale (VAS) scores were significantly improved in both groups compared with preoperatively. SPC guided screw placement was more accurate than the fluoroscopy-assisted FH technique for single-level MIDLF at L4/5. Patients undergoing SPC-guided screw placement can achieve similar clinical outcomes as the fluoroscopy-assisted FH technique.
Collapse
Affiliation(s)
- Xi-Nuo Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Qing-Jun Su
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Bao-Qing Pei
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Ai-Xing Pan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Hong-Hao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Hong-Tao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China
| | - Yu-Zeng Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
3
|
Huang Y, Maimaiti A, Tian Y, Li Z, Kahaer A, Rexiti P. Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis. J Orthop Surg Res 2023; 18:549. [PMID: 37525283 PMCID: PMC10388474 DOI: 10.1186/s13018-023-04027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ying Huang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | | | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
| |
Collapse
|
4
|
Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
Collapse
Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
| |
Collapse
|
5
|
Tan Y, Wang Y, Ding H, Zhang S, Li X, Zhou X, Lai J. Resection of cervical hemivertebra with occipitocervical - fusion: report on two torticollis cases and literature review. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 36823981 DOI: 10.1080/02648725.2023.2178182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 02/25/2023]
Abstract
The objective of this study is to present the two cases of cervical hemivertebra and torticollis, and To describe technique and result of cervical hemivertebra resection and torticollis correction via a anterior-posterior surgical approach and occipitocervical fusion. Cervical hemivertebra, accompanied by abipartite atlas, agenesis of odontoid and C2 segmental type of vertebral artery (VA), is a rare, but complex congenital anomalies, associated with cervical scoliosis and occipitocervical instability. To the best of our knowledge, this is the first report on such congenital anomaly and deformity correction via anterior-posterior hemivertebra resection with occipitocervical fusion. Two patients were presented with torticollis due to congenital cervical hemivertebra accompanied by abipartite atlas, agenesis of odontoid and C2 segmental type of VA. Deformity correction was executed by an anterior-posterior hemivertebra resection and occipitocervical fusion with segment instrumentation. The treatment course was uneventful and clinical outcomes was favorable. The radiographs showed a satisfactory deformity correction with a well-balanced coronal and sagittal alignment. Hemivertebra resection with occipitocervical fusion could correct torticollis with satisfactory clinical and radiographical outcome.
Collapse
Affiliation(s)
- Yixuan Tan
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Yu Wang
- Department of Language, Huzhou University, Huzhou, Zhejiang, China
| | - Hao Ding
- Department of Orthopaedics, Medical School of Nanjing University, Huzhou, Zhejiang, China
| | - Shuhan Zhang
- Department of Anesthesiology, Shanghai changzheng Hospital, Shanghai, China
| | - Xiaoming Li
- Department of Orthopedics, Huzhou University, Huzhou, Zhejiang, China
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Jin Lai
- Department of Orthopedics, Huzhou University, Huzhou, Zhejiang, China
| |
Collapse
|
6
|
Di Perna G, Marengo N, Matsukawa K, Mahieu G, Baldassarre BM, Petrone S, De Marco R, Zeppa P, Ajello M, Fiumefreddo A, Zenga F, Garbossa D, Cofano F. Three-Dimensional Patient-Matched Template Guides Are Able to Increase Mean Diameter and Length and to Improve Accuracy of Cortical Bone Trajectory Screws: A 5-Year International Experience. World Neurosurg 2023; 170:e542-e549. [PMID: 36402304 DOI: 10.1016/j.wneu.2022.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze whether significant differences exist between free-hand three-dimensional (3D) planning-guided cortical bone trajectory (CBT) screw placement and 3D-printed template-guided CBT screw positioning in terms of accuracy, size of screws, and potential complications. METHODS In this retrospective study, data of adult patients in whom CBT screws were placed for lumbar degenerative pathologies were extracted from a prospectively collected database and analyzed. Patients in whom screws were placed using free-hand 3D planning-guided technique were compared with patients in whom screws were positioned using customized 3D-printed templates. Size of the screws, accuracy, clinical outcomes, and complications were analyzed. RESULTS The study evaluated 251 patients (1004 screws). The free-hand 3D planning-guided group included 158 patients (632 screws), and the 3D-printed template-guided group included 93 patients (372 screws). The 3D-printed template-guided group involved screws of larger size from L3 to S1. Differences between the 2 groups in terms of accuracy parameters reached statistical significance (P ≤ 0.05). CONCLUSIONS With the use of 3D patient-matched template guides, mean diameter and length of CBT screws could be safely increased due to improved accuracy of screw placement. Based on previous evidence regarding CBT biomechanical properties, these advantages could allow increased fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies are needed.
Collapse
Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, "Casa di Cura Clinica Città di Bra", Bra, Italy
| | - Nicola Marengo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Geert Mahieu
- Orthopaedic Surgery Department, ORTHOCA - AZ Monica Hospital, Antwerp, Belgium
| | | | | | - Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Marco Ajello
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Alessandro Fiumefreddo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Francesco Zenga
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| |
Collapse
|
7
|
Wang Y, Kahaer A, Shi W, Guo H, Rexiti P. Morphometric measurement of lumbar pedicle in different regions: a systematic review. J Orthop Surg Res 2023; 18:30. [PMID: 36631862 PMCID: PMC9832728 DOI: 10.1186/s13018-023-03499-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. METHODS Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. RESULTS Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. CONCLUSIONS People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.
Collapse
Affiliation(s)
- Yixi Wang
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Paerhati Rexiti
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| |
Collapse
|
8
|
Guo S, Zhu K, Yan MJ, Li XH, Tan J. Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis. World J Clin Cases 2022; 10:13179-13188. [PMID: 36683619 PMCID: PMC9850985 DOI: 10.12998/wjcc.v10.i36.13179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
Lumbar degenerative disc disease (DDD) in the elderly population remains a global health problem, especially in patients with osteoporosis. Osteoporosis in the elderly can cause failure of internal fixation. Cortical bone trajectory (CBT) is an effective, safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis. In this review, we analyzed the anatomy, biomechanics, and advantages of the CBT technique in lumbar DDD and revision surgery. Additionally, the clinical trials and case reports, indications, advancements and limitations of this technique were further discussed and reviewed. Finally, we concluded that the CBT technique can be a practical, effective and safe alternative to traditional pedicle screw fixation, especially in DDD patients with osteoporosis.
Collapse
Affiliation(s)
- Song Guo
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Kai Zhu
- Department of Orthopedics Ⅱ, Qingdao No. 8 People’s Hospital, Qingdao 266121, Shandong Province, China
| | - Mei-Jun Yan
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xin-Hua Li
- Department of Orthopedics Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Jun Tan
- Department of Orthopedics, United Family Healthcare, Shanghai 200336, China
| |
Collapse
|
9
|
Zhang XN, Zhang YQ, Liu YZ, Su QJ, Guan L, Li DY, Pei BQ, Pan AX, Yang HH, Ding HT, Hai Y, Zhou LJ. Cortical screw placement with a spinous process clamp guide: a cadaver study accessing accuracy. BMC Surg 2022; 22:384. [PMID: 36348354 PMCID: PMC9644622 DOI: 10.1186/s12893-022-01829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Background and objective The Cortical Bone Trajectory (CBT) technique provides an alternative method for fixation in the lumbar spine in patients with osteoporosis. An accuracy CBT screw placement could improve mechanical stability and reduce complication rates. Purpose The purpose of this study is to explore the accuracy of cortical screw placement with the application of implanted spinous process clip (SPC) guide. Methods and materials Four lumbar specimens with T12-S1 were used to access the accuracy of the cortical screw. The SPC-guided planning screws were compared to the actual inserted screws by superimposing the vertebrae and screws preoperative and postoperative CT scans. According to preoperative planning, the SPC guide was adjusted to the appropriate posture to allow the K-wire drilling along the planned trajectory. Pre and postoperative 3D-CT reconstructions was used to evaluate the screw accuracy according to Gertzbein and Robbins classification. Intraclass correlation coefficients (ICCs) and Bland–Altman plots were used to examine SPC-guided agreements for CBT screw placement. Results A total of 48 screws were documented in the study. Clinically acceptable trajectory (grades A and B) was accessed in 100% of 48 screws in the planning screws group, and 93.8% of 48 screws in the inserted screws group (p = 0.242). The incidence of proximal facet joint violation (FJV) in the planning screws group (2.1%) was comparable to the inserted screws group (6.3%) (p = 0.617). The lateral angle and cranial angle of the planned screws (9.2 ± 1.8° and 22.8 ± 5.6°) were similar to inserted screws (9.1 ± 1.7° and 23.0 ± 5.1°, p = 0.662 and p = 0.760). Reliability evaluated by intraclass correlation coefficients and Bland–Altman showed good consistency in cranial angle and excellent results in lateral angle and distance of screw tip. Conclusions Compared with preoperative planning screws and the actually inserted screws, the SPC guide could achieve reliable execution for cortical screw placement.
Collapse
|
10
|
Kahaer A, Maimaiti X, Maitirouzi J, Wang S, Shi W, Abuduwaili N, Zhou Z, Liu D, Maimaiti A, Rexiti P. Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis. Front Surg 2022; 9:911742. [PMID: 35923441 PMCID: PMC9339714 DOI: 10.3389/fsurg.2022.911742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHybrid fixation techniques including the both modified cortical bone trajectory (MCBT) and traditional trajectory (TT) at the L4 and L5 lumbar segment are firstly proposed by our team. Therefore, the purpose of this study is to evaluate and provide specific biomechanical data of the hybrid fixation techniques including the MCBT and TT.MethodsFour human cadaveric specimens were from the anatomy laboratory of Xinjiang Medical University. Four finite-element (FE) models of the L4–L5 lumbar spine were generated. For each of them, four implanted models with the following fixations were established: TT-TT (TT screw at the cranial and caudal level), MCBT-MCBT (MCBT screw at the cranial and caudal level), hybrid MCBT-TT (MCBT screw at the cranial level and TT screw at the caudal level), and TT-MCBT (TT screw at the cranial level and MCBT screw at the caudal level). A 400-N compressive load with 7.5 N/m moments was applied to simulate flexion, extension, lateral bending, and 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 were compared.ResultsCompared to the TT-TT group, the MCBT-TT showed a significant lower ROM of the L4–L5 segment (p ≤ 0.009), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.041). TT-MCBT groups showed a significant lower ROM of the L4–L5 segment (p ≤ 0.012), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.038).ConclusionsThe biomechanical properties of the hybrid MCBT-TT and TT-MCBT techniques at the L4–L5 segment are superior to that of stability MCBT-MCBT and TT-TT techniques, and feasibility needs further cadaveric study to verify.
Collapse
Affiliation(s)
- Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Wenjie Shi
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Nueraihemaiti Abuduwaili
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhihao Zhou
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dongshan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Correspondence: Paerhati Rexiti
| |
Collapse
|
11
|
Chung TT, Chu CL, Hueng DY, Lin SC. A parametric investigation on traditional and cortical bone trajectory screws for transpedicular fixation. BMC Musculoskelet Disord 2022; 23:612. [PMID: 35761302 PMCID: PMC9235223 DOI: 10.1186/s12891-022-05477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Many studies have been conducted to compare traditional trajectory (TT) and cortical bone trajectory (CBT) screws; however, how screw parameters affect the biomechanical properties of TT and CBT screws, and so their efficacy remains to be investigated. Methods A finite element model was used to simulate screws with different trajectories, diameters, and lengths. Responses for implant and tissues at the adjacent and fixed segments were used as the comparison indices. The contact lengths and spanning areas of the inserted screws were defined and compared across the varieties. Results The trajectory and diameter had a greater impact on the responses from the implant and tissues than the length. The CBT has shorter length than the TT; however, the contact length and supporting area of the CBT within the cortical bone were 19.6%. and 14.5% higher than those of the TT, respectively. Overall, the TT and CBT were equally effective at stabilizing the instrumented segment, except for bending and rotation. The CBT experienced less adjacent segment compensations than the TT. With the same diameter and length, the TT was considerably less stressed than the CBT, especially for flexion and extension. Conclusions The CBT may provide less stress at adjacent segments compared with the TT. The CBT may provide more stiffer in osteoporotic segments than the TT due to greater contact with cortical bone and a wider supporting base between the paired screws. However, both entry point and insertion trajectory of the CBT should be carefully executed to avoid vertebral breach and ensure a stable cone-screw purchase.
Collapse
|
12
|
Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
Collapse
|
13
|
Li Y, Chen L, Liu Y, Ding H, Lu H, Pan A, Zhang X, Hai Y, Guan L. Accuracy and safety of robot-assisted cortical bone trajectory screw placement: a comparison of robot-assisted technique with fluoroscopy-assisted approach. BMC Musculoskelet Disord 2022; 23:328. [PMID: 35387621 PMCID: PMC8988323 DOI: 10.1186/s12891-022-05206-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the safety and accuracy of cortical bone trajectory screw placement between the robot-assisted and fluoroscopy-assisted approaches. Methods This retrospective study was conducted between November 2018 and June 2020, including 81 patients who underwent cortical bone trajectory (CBT) surgery for degenerative lumbar spine disease. CBT was performed by the same team of experienced surgeons. The patients were randomly divided into two groups—the fluoroscopy-assisted group (FA, 44 patients) and the robot-assisted group (RA, 37 patients). Robots for orthopedic surgery were used in the robot-assisted group, whereas conventional fluoroscopy-guided screw placement was used in the fluoroscopy-assisted group. The accuracy of screw placement and rate of superior facet joint violation were assessed using postoperative computed tomography (CT). The time of single screw placement, intraoperative blood loss, and radiation exposure to the surgical team were also recorded. The χ2 test and Student’s t-test were used to analyze the significance of the variables (P < 0.05). Results A total of 376 screws were inserted in 81 patients, including 172 screws in the robot-assisted group and 204 pedicle screws in the fluoroscopy-assisted group. Screw placement accuracy was higher in the RA group (160, 93%) than in the FA group (169, 83%) (P = 0.003). The RA group had a lower violation of the superior facet joint than the FA group. The number of screws reaching grade 0 in the RA group (58, 78%) was more than that in the FA group (56, 64%) (P = 0.041). Screw placement time was longer in the FA group (7.25 ± 0.84 min) than in the RA group (5.58 ± 1.22 min, P < 0.001). The FA group had more intraoperative bleeding (273.41 ± 118.20 ml) than the RA group (248.65 ± 97.53 ml, P = 0.313). The radiation time of the FA group (0.43 ± 0.07 min) was longer than the RA group (0.37 ± 0.10 min, P = 0.001). Furthermore, the overall learning curve tended to decrease. Conclusions Robot-assisted screw placement improves screw placement accuracy, shortens screw placement time, effectively improves surgical safety and efficiency, and reduces radiation exposure to the surgical team. In addition, the learning curve of robot-assisted screw placement is smooth and easy to operate.
Collapse
Affiliation(s)
- Yue Li
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Long Chen
- Department of Orthopedics, Guangzhou Red Cross Hospital Affiliated To Jinan University, No. 396, Mid Tongfu Road, Haizhu District, Guangzhou, 510000, Guangdong, P. R. China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Hongtao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Hongyi Lu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Xinuo Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| |
Collapse
|
14
|
Kidwell RL, Tan LA. Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-Up. Oper Neurosurg (Hagerstown) 2021; 22:e117-e119. [DOI: 10.1227/ons.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
|
15
|
The C2 Cortical Screw, an Alternative Fixation Technique for the C2 Segment During High Cervical Spine Surgery: Technical Note. World Neurosurg 2020; 142:24-28. [PMID: 32599192 DOI: 10.1016/j.wneu.2020.06.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND For posterior fixation of C2 vertebra (the axis), several fixation techniques such as pedicle screw, laminar screw, and pars screw have been reported. A pedicle screw (PS) is considered the strongest among the techniques, but certain situations make PS fixation impossible or difficult. These include patients with a narrow C2 pedicle or high-riding vertebral artery. We introduced an alternative screw technique for C2 that addressed the aforementioned problems with safely placing it, which we termed a cortical screw (CS) for C2. METHODS Among a total of 28 cases using C2 CS for high cervical spine surgery, 2 cases using C2 CS were described. One patient was a 76-year old woman with a gait disturbance and myelopathic symptoms and diagnosed with C1-C2 myelopathy and translational instability. The other case was 54-year old man with posterior neck pain after traffic accident and diagnosed with C1-C2 fracture-dislocation. We used the C2 CS as an alternative technique for high cervical spine surgery in these patients and describe the ideal entry point and trajectory. RESULTS A postoperative computed tomography scan confirmed proper positioning of the C1 posterior arch screw and C2 CS, with satisfactory reduction of the C2 dens and adequate restoration of the C1-C2 spinal canal. The patient experienced no screw-related postoperative complications, and postoperative 1-year computed tomography images showed that solid union and good alignment of C1-2 segment was achieved. CONCLUSIONS C2 CS can be suitable alternative for C2 screw fixation technique in posterior high cervical spine fusion surgery.
Collapse
|