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Cortical bone trajectory

Gun Woo Lee, Ji-Hoon Shin
OBJECTIVE: To present a minimally-invasive surgical technique using cortical bone trajectory-pedicle screw (cortical screw, CS) for adjacent segment pathology (ASP) after lumbar fusion surgery, and to thoroughly compare postoperative outcomes of the two surgical techniques with either CS or conventional pedicle screw (PS) for ASP in one year follow-up time. METHODS: Among 59 patients who underwent surgical treatment for proximal ASP after lumbar fusion surgery, 53 patients who met the study criteria (group A, 31 patients with conventional technique using PS; group B, 22 patients with minimally-invasive technique using CS) were enrolled in the study...
June 5, 2018: World Neurosurgery
Shiyuan Shi, Xiaozhang Ying, Qi Zheng, Bo Zhu, Yanghui Jin, Jian Shen, Mingfeng Zheng, Shunping Hu
OBJECTIVE: To investigate the clinical efficacy of cortical bone trajectory screws (CBTs) in the treatment of elderly patients with lumbar spinal tuberculosis. METHODS: A total of 45 elderly patients with lumbar spinal tuberculosis were allocated to two groups based on different surgical methods: 22 patients in Group A received posterior CBT fixation combined with anterior debridement with a small incision and bone grafting, and 23 patients in Group B underwent posterior pedicle screw fixation combined with anterior debridement with a small incision and bone grafting...
June 1, 2018: World Neurosurgery
Jun Xuan, Chen-Long Xie, Yang Wu, Jian Chen, Xin Tong, Xiang-Yang Wang, Hui Xu
OBJECTIVE: To assess an alternative method of cortical bone trajectory (CBT) screw placement in thoracic spine from T1 to T8, and investigate the proper entry point, screw insertion angle, screw length and diameter. METHODS: Computed tomography (CT) images of eighty patients were used to measure all related parameters. Ten cadaveric spines were included to study and 4.5 mm screws were inserted into both sides of vertebrae. CT scans of all vertebrae previously inserted with CBT screws were done and we checked lateral or medial pedicle wall violation...
May 30, 2018: World Neurosurgery
Jun Peng, Yulin Zhan, Yingjie Liu, Yang Zong, Yanjie Mao
Objective: To compare the effectiveness of cortical bone trajectory screw (CBTS) and conventional pedicle screw for posterior lumbar interbody fusion (PLIF) in the treatment of single segment lumbar degenerative disease. Methods: Between May 2013 and May 2016, a total of 97 patients with single segment lumbar degenerative disease were treated with PLIF. Fifty-one patients were fixed with CBTS in PLIF (trajectory screw group) and 46 with pedicle screw (pedicle screw group)...
November 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Hai Gao, Renjie Zhang, Chongyu Jia, Tao Xing, Jianxiang Zhang, Fulong Dong, Peng Ge, Peiwen Song, Peng Xu, Huaqing Zhang, Huimin Li, Cailiang Shen
STUDY DESIGN: This is a radiographic and cadaveric study. OBJECTIVE: The aim of this study was to conduct a detailed comparison about the parameters between the ideal cortical bone trajectory (CBT) and practical CBT screw. SUMMARY OF BACKGROUND DATA: CBT screws have recently become popular in spinal surgery, mainly because of their improved fixation while minimizing soft tissue dissection. However, to our knowledge, no previous study has provided a detailed comparison on the parameters between the ideal CBT and practical CBT screws...
May 18, 2018: Clinical Spine Surgery
Shunji Asamoto, Kota Kojima, Michael Winking, Andreas Jödicke, Masayuki Ishikawa, Shinichi Ishihara, Wolfgang Deinsberger, Jun Muto, Makoto Nishiyama
BACKGROUND:  Cortical bone trajectory (CBT) is a relatively new technique for pedicle screw insertion in the field of spine surgery. Previous studies have demonstrated the significantly better pullout and toggle characteristics the new method offers, and it appears to have certain advantages over the widely used traditional trajectory. The mechanism of the pullout and toggle characteristics still remains unknown. PURPOSE:  To report the medium- to long-term follow-up findings of patients who underwent posterior lumbar interbody fusion or posterior lumbar fusion (PLIF/PLF) at our institution and to discuss the ideal screw trajectory when using this technique...
April 30, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Atul Goel
No abstract text is available yet for this article.
April 27, 2018: Journal of Neurosurgery. Spine
Nicola Marengo, Marco Ajello, Michele Federico Pecoraro, Giulia Pilloni, Giovanni Vercelli, Fabio Cofano, Francesco Zenga, Alessandro Ducati, Diego Garbossa
Introduction: A prospective comparative study between classical posterior interbody fusion with peduncular screws and the new technique with divergent cortical screws was conducted. Material and Methods: Only patients with monosegmental degenerative disease were recruited into this study. We analyzed a cohort of 40 patients treated from January 2015 to March 2016 divided into 2 groups (20 patients went to traditional open surgery and 20 patients under mini-invasive strategy)...
2018: BioMed Research International
Peng Peng, Yafei Xu, Xintao Zhang, Meisong Zhu, Bingran Du, Wenrui Li, Wenhua Huang, Jun Song, Jianyi Li
BACKGROUND: This study aimed to develop patient-specific drill templates by computer numerical control or three-dimensional printing via two cortical bone trajectories (CBTs) and to evaluate their efficacies and accuracies in cervical anterior transpedicular insertion. METHODS: Preoperative CT images of 20 cadaveric cervical vertebrae (C3-C7) were obtained. After image processing, patient-specific drill templates were randomly assigned to be constructed via two CBTs (CBT0 and CBT0...
April 18, 2018: Journal of Orthopaedic Surgery and Research
Nicola Marengo, Pedro Berjano, Fabio Cofano, Marco Ajello, Francesco Zenga, Giulia Pilloni, Federica Penner, Salvatore Petrone, Lorenzo Vay, Alessandro Ducati, Diego Garbossa
PURPOSE: The use of cortical bone trajectory (CBT) pedicle screws for circumferential interbody fusion represents a viable alternative for single-level procedure with reduced invasiveness and less tissue destruction than the traditional technique. In addition, CBT screws have a potentially stronger pullout strength because of the greater amount of cortical bone intercepted. Only few series exist evaluating clinical and radiological outcomes of CBT screws. METHODS: This is a retrospective cohort study...
April 16, 2018: European Spine Journal
B Javaheri, H Razi, M Piles, R de Souza, Y-M Chang, I Maric-Mur, M Hopkinson, P D Lee, A A Pitsillides
OBJECTIVES: Human osteoarthritis (OA) is detected only at late stages. Male STR/Ort mice develop knee OA spontaneously with known longitudinal trajectory, offering scope to identify OA predisposing factors. We exploit the lack of overt OA in female STR/Ort and in both sexes of parental, control CBA mice to explore whether early divergence in tibial bone mass or shape are linked to emergent OA. METHOD: We undertook detailed micro-CT comparisons of trabecular and cortical bone, multiple structural/architectural parameters and finite element modelling (FEM) of the tibia from male and female STR/Ort and CBA mice at 8-10 (pre-OA), 18-20 (OA onset) and 40 + weeks (advanced OA) of age...
June 2018: Osteoarthritis and Cartilage
Anja Tschugg, Pujan Kavakebi, Sebastian Hartmann, Sara Lener, Christoph Wipplinger, Wolfgang N Löscher, Sabrina Neururer, Matthias Wildauer, Claudius Thomé
BACKGROUND: Spinal fusion with pedicle screw fixation represents the gold standard for lumbar degenerative disc disease with instability. Although it is an established technique, it is nevertheless an invasive intervention with high complication rates. Therefore, minimally invasive approaches have been developed, the medialized bilateral screw pedicel fixation (mPACT) being one of them. The study objective is to evaluate prospectively the efficacy and safety of the mPACT technique compared with the traditional trajectory for degenerative lumbar spondylolisthesis...
February 20, 2018: Trials
Michael A Bohl, Randall J Hlubek, U Kumar Kakarla, Steve W Chang
BACKGROUND: A major drawback to use of cortical bone trajectory pedicle screws (CBTPSs) with traditional posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion grafts is that traditional graft insertion trajectories require wider posterior exposure. This wider exposure, beyond the limits otherwise required for CBTPS placement, negates a primary benefit of CBTPS fixation. The aim of this study was to define an alternative surgical technique for interbody graft placement that, when used in conjunction with CBTPS fixation, permits both minimal soft tissue dissection and optimal graft placement...
May 2018: World Neurosurgery
Kevin Phan, Ralph J Mobbs
No abstract text is available yet for this article.
February 2018: World Neurosurgery
Leigh Gabel, Heather M Macdonald, Lindsay A Nettlefold, Heather A McKay
There are presently no adolescent centile curves for bone parameters at the tibial midshaft using peripheral quantitative computed tomography (pQCT) or at the distal radius and tibia using high-resolution pQCT (HR-pQCT). Thus, we aimed to develop sex-, ethnic-, site-, and age-specific centile curves for pQCT and HR-pQCT-derived bone outcomes for youth and young adults aged 10 to 21 years. We acquired pQCT scans (XCT3000 or XCT2000) at the tibial midshaft (50% site) and HR-pQCT scans (XtremeCT) at the distal radius (7% site) and tibia (8% site) in a convenience sample of participants in the mixed-longitudinal University of British Columbia Healthy Bones III Study...
February 2, 2018: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Kevin Phan, Vignesh Ramachandran, Tommy M Tran, Kevin P Shah, Matthew Fadhil, Alan Lackey, Nicholas Chang, Ai-Min Wu, Ralph J Mobbs
Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws...
December 2017: Journal of Spine Surgery (Hong Kong)
David Buehlmann, Joanes Grandjean, Jael Xandry, Markus Rudin
Functional neuroimaging has emerged as attractive option for characterizing pain states complementing behavioral readouts or clinical assessment. In particular, resting-state functional magnetic resonance imaging (rs-fMRI) enables monitoring of functional adaptations across the brain, for example, in response to chronic nociceptive input. We have used rs-fMRI in a mouse model of chronic pain from breast cancer-derived tibial bone metastases to identify pain-induced alterations in functional connectivity. Combined assessment of behavioral readouts allowed for defining a trajectory as model function for extracting pain-specific functional connectivity changes from the fMRI data reflective of a chronic pain state...
April 2018: Pain
Michal Szczodry, Giovanni F Solitro, Farid Amirouche, Priyesh Patel
STUDY DESIGN: Comparison, in terms of insertion accuracy and biomechanical performance, between an increased cortical purchase and straightforward pedicle screw trajectory. OBJECTIVE: This study aims to compare a trajectory with increased cortical purchase to the more common straightforward trajectory in terms of strength and insertion accuracy using real-time navigation. SUMMARY OF BACKGROUND DATA: In previous studies, it was suggested that pedicle screw pullout strength is strongly correlated with bone mineral density, and using a more cortical tract allows a greater portion of the denser bone, the cortex, to be in contact with the screw...
January 2018: Spine Deformity
Keitaro Matsukawa, Yuichiro Abe, Yoshihide Yanai, Yoshiyuki Yato
BACKGROUND: The sufficiency of screw anchoring is a critical factor for achieving successful spinal fusion; however, no reliable method for predicting pedicle screw fixation has been established. Recently, Hounsfield units (HU) obtained from computed tomography (CT) was developed as a new reliable tool to determine the bone quality. The purpose of the present study was to demonstrate the utility of regional HU measurement of the screw trajectory to predict the primary and long-term fixation strength of pedicle screws...
February 2018: Acta Neurochirurgica
Chao-Hsuan Chen, Hsieng-Ming Huang, Der-Cherng Chen, Chih-Ying Wu, Han-Chun Lee, Der-Yang Cho
Lumbar adjacent segment disease after lumbar fusion surgery often requires surgical intervention. However, subsequent surgical treatment often needs to expose and remove all of the previous instruments. This additional surgery leads to significant post-operative pain, muscular fibrosis, poor wound healing and infection, etc. From October 2015 to March 2016, we collected six cases underwent cortical bone trajectory screws fixation with minimal invasive inter-body cage fusion for lumbar adjacent segment disease...
February 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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