Cortical bone trajectory and traditional trajectory—a radiological evaluation of screw-bone contact

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• 作者：Kota Kojima ; Shunji Asamoto ; Yoshiomi Kobayashi ; Masayuki Ishikawa…
• 关键词：Cortical bone trajectory ; Screw ; to ; bone contact ; Radiological study ; CT number ; Hounsfield unit ; Posterior lumbar spine fusion
• 刊名：Acta Neurochirurgica
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：157
• 期：7
• 页码：1173-1178
• 全文大小：1,426 KB
• 参考文献：1.Perez-Orribo L, Kalb S, Reyes P, Chang S, Crawford N (2013) Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine 38:635-41PubMed View Article
  2.Santoni BG, Hynes RA, McGilvray KC, Rodriquez-Canessa G, Lyons AS, Henson MAW, Womack WJ, Puttlitz CM (2009) Cortical bone trajectory for lumbar pedicle screws. Spine J 9(5):366-73PubMed View Article
  3.Crookshank M, Ploeg H, Ellis R, Maclntyre J (2014) Repeatable calibration of Hounsfield units to mineral density and effects of scanning medium. Adv Biomech Appl 1(1):15-2View Article
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  5.Asamoto S (2013) Cortical bone trajectory -the buttress effect theory. Annual meeting of the Japanese Society of Spinal Surgery, Nagoya, Japan
  6.Cyron BM, Hutton WC (1979) Variations in the amount and distribution of cortical bone across the partes interarticulares of L5. Spine 4(2):163-67PubMed View Article
  7.Krenz J, Troup JD (1973) The structure of the pars interarticularis of the lower lumbar vertebrae and its relation to the etiology of spondylolysis. J Bone Joint Surg (Br) 55(4):735-41
  8.Cho W, Cho W, Wu C (2010) The biomechanics of pedicle screw based instrumentation. J Bone Joint Surg 92(8):1061-065View Article
  
• 作者单位：Kota Kojima (1) (2)
  Shunji Asamoto (1)
  Yoshiomi Kobayashi (2)
  Masayuki Ishikawa (1)
  Yasuyuki Fukui (1)
  
  1. Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, 1-4-3 Mita, Tokyo, 108-8329, Japan
  2. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
  
• 刊物主题：Neurosurgery; Interventional Radiology; Neuroradiology; Neurology; Surgical Orthopedics; Minimally Invasive Surgery;
• 出版者：Springer Vienna
• ISSN：0942-0940

文摘

Background Cortical bone trajectory (CBT), a relatively new technique for pedicle screw insertion in the lumbar spine, is believed to have equivalent pullout and toggle characteristics compared with the traditional trajectory (TT). It has been hypothesized that the new trajectory offers higher cortical bone contact with the pedicle screws and therefore has an improved anchoring property over the traditional trajectory where the screws are inserted into the vertebral body trabecular space. The aim of this study is to evaluate the pedicle screw-cortical bone contact between the two trajectories from a radiological standpoint. Methods Two hundred twenty-two patients with degenerative lumbar spine disease underwent computed tomography scanning. For each patient, axial slices of the L4 and L5 vertebra were cut in two planes, one horizontal to the pedicle representing the plane at which pedicle screws are inserted using the TT and another in a more caudo-cranial?plane representing the plane at which pedicle screws are inserted using CBT. For each trajectory, a region of interest (ROI) was selected within the area in which the screws are inserted. A CT number (Hounsfield scale) was then calculated within each ROI to compare the bone density. Results The CT numbers within the ROI for CBT were constantly almost over four times higher than that for the TT, and there was a significant difference between the values (p-lt;-.0001). Conclusions This study has demonstrated that, with the cortical bone trajectory, the pedicle screws penetrate a region that is richer in cortical bone compared to when using the traditional trajectory. This is in keeping with previous hypotheses that the new trajectory offers higher cortical bone contact.