Radiological Evaluation of the Initial Fixation between Cortical Bone Trajectory and Conventional Pedicle Screw Technique for Lumbar Degenerative Spondylolisthesis

Study Design Retrospective study. Purpose To compare initial fixation using the cortical bone trajectory (CBT) technique versus conventional pedicle screws (PS) in radiographs of postsurgical lumbar degenerative spondylolisthesis. Overview of Literature Few reports have documented the holding strength of CBT technique for spondylolisthesis cases. Methods From October 2009 to June 2014, 21 cases of degenerative spondylolisthesis were surgically treated in our institution. Ten were treated with conventional PS technique and 11 of with CBT technique. Mean lumbar lordosis and percent slippage were evaluated preoperatively, immediately after surgery, and 6 months and 1 year postoperatively using radiographs. We also investigated percent loss of slip reduction. Results There were statistically significant differences between preoperative percent slippage and postoperative slippage in both PS and CBT procedures over 1 year, and both techniques showed good slip reduction. On the other hand, lumbar lordosis did not change significantly in either the PS or CBT groups over 1 year. Conclusions CBT technique showed similarly good initial fixation compared with the PS procedure in the treatment of lumbar degenerative spondylolisthesis.

[1]  W C Hutton,et al.  Correlations between screw hole preparation, torque of insertion, and pullout strength for spinal screws. , 1994, Journal of spinal disorders.

[2]  K. Okuyama,et al.  Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion. , 2000, Spine.

[3]  B. Myers,et al.  The Role of Imaging and In Situ Biomechanical Testing in Assessing Pedicle Screw Pull‐Out Strength , 1996, Spine.

[4]  K. Sairyo,et al.  Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: a technical note. , 2014, The journal of medical investigation : JMI.

[5]  C. Puttlitz,et al.  Cortical bone trajectory for lumbar pedicle screws. , 2009, The spine journal : official journal of the North American Spine Society.

[6]  T. Asazuma,et al.  In Vivo Analysis of Insertional Torque During Pedicle Screwing Using Cortical Bone Trajectory Technique , 2014, Spine.

[7]  T. Yoshimine,et al.  Isthmus‐guided Cortical Bone Trajectory for Pedicle Screw Insertion , 2014, Orthopaedic surgery.

[8]  K. Okuyama,et al.  PLIF With a Titanium Cage and Excised Facet Joint Bone for Degenerative Spondylolisthesis—In Augmentation With a Pedicle Screw , 2007, Journal of spinal disorders & techniques.

[9]  D N Kunz,et al.  Pedicle Screw Pullout Strength: Correlation with Insertional Torque , 1993, Spine.

[10]  M. Nevitt,et al.  Vertebral fracture assessment using a semiquantitative technique , 1993, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[11]  A. Tencer,et al.  Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation. , 1993, Spine.

[12]  J N Weinstein,et al.  Anatomic and technical considerations of pedicle screw fixation. , 1992, Clinical orthopaedics and related research.

[13]  A. Nene,et al.  Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips , 2011, Indian journal of orthopaedics.

[14]  H. Boehm,et al.  Reoperation Rate After Instrumented Posterior Lumbar Interbody Fusion: A Report on 1680 Cases , 2004, Spine.

[15]  H. Yamada,et al.  Lumbar Sagittal Balance Influences the Clinical Outcome After Decompression and Posterolateral Spinal Fusion for Degenerative Lumbar Spondylolisthesis , 2002, Spine.