Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory

Yuji Kasukawa, Naohisa Miyakoshi, Michio Hongo, Yoshinori Ishikawa, Daisuke Kudo, Yoichi Shimada, Yuji Kasukawa, Naohisa Miyakoshi, Michio Hongo, Yoshinori Ishikawa, Daisuke Kudo, Yoichi Shimada

Abstract

Study design: Case-control study.

Purpose: To evaluate clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) performed with cortical bone trajectory (CBT) pedicle screw insertion with those of TLIF using 'conventional' or percutaneous pedicle screw insertion.

Overview of literature: CBT is a new trajectory for pedicle screw insertion in the lumbar spine; clinical and radiological results of TLIF using pedicle screws inserted with CBT are unclear.

Methods: In total, 26 patients (11 males, 15 females) were enrolled in this retrospective study and divided into three groups: TLIF with pedicle screw insertion by conventional minimally invasive methods via the Wiltse approach (M-TLIF, n=10), TLIF with percutaneous pedicle screw insertion (P-TLIF, n=6), and TLIF with pedicle screw insertion with CBT (CBT-TLIF, n=10). Surgical results and preand postoperative radiological findings were evaluated and compared.

Results: Intraoperative blood loss was significantly less with CBT-TLIF (p=0.03) than with M-TLIF. Postoperative lordotic angles did not differ significantly among the three groups. Complete fusions were obtained in 10 of 12 levels (83%) with M-TLIF, in seven levels (100%) with P-TLIF, and in 10 of 11 levels (91%) with CBT-TLIF. On postoperative computed tomography, correct positioning was seen in 84.1% of M-TLIF screws, 88.5% of P-TLIF screws, and 90% of CBT-TLIF screws.

Conclusions: CBT-TLIF resulted in less blood loss and a shorter operative duration than M-TLIF or P-TLIF. Postoperative rates of bone union, maintenance of lordotic angles, and accuracy of pedicle screw positions were similar among the three groups.

Keywords: Computed tomography; Conventional trajectory; Cortical bone trajectory; Percutaneous insertion; Transforaminal lumbar interbody fusion.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Lateral radiographs of M-TLIF. (A)…
Fig. 1. Lateral radiographs of M-TLIF. (A) Preoperative radiograph, (B) postoperative radiograph, (C) radiograph at final follow-up. M-TLIF, transforaminal lumbar interbody fusion with minimally invasive pedicle screw insertion.
Fig. 2. Lateral radiographs of P-TLIF. Preoperative…
Fig. 2. Lateral radiographs of P-TLIF. Preoperative radiograph (A), postoperative radiograph (B), and radiograph at final follow-up (C). P-TLIF, transforaminal lumbar interbody fusion with percutaneous pedicle screw insertion.
Fig. 3. Lateral radiographs of CBT-TLIF. (A)…
Fig. 3. Lateral radiographs of CBT-TLIF. (A) Preoperative radiograph, (B) postoperative radiograph, and (C) radiograph at final follow-up. CBT-TLIF, transforaminal lumbar interbody fusion with pedicle screw insertion with cortical bone trajectory.
Fig. 4. Postoperative computed tomography of pedicle…
Fig. 4. Postoperative computed tomography of pedicle screw placement. Pedicle screw inserted conventionally or percutaneously in correct position (A), in contact with medial wall (B). Pedicle screw inserted with cortical bone trajectory in correct position (C), in contact with medial wall (D).

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Source: PubMed

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