Preoperative 3D CT Planning for Cortical Bone Trajectory Screws: A Retrospective Radiological Cohort Study.
Adult
Aged
Arthrodesis
Bone Screws
Cohort Studies
Female
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Lumbosacral Region
Male
Middle Aged
Neurosurgical Procedures
/ methods
Orthopedic Procedures
/ methods
Preoperative Care
Retrospective Studies
Spinal Diseases
/ diagnostic imaging
Spinal Fusion
/ methods
Tomography, X-Ray Computed
Cortical bone trajectory
Lumbar arthrodesis
Lumbar spine surgery
Minimally invasive surgery
Planning
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
17
12
2018
revised:
11
03
2019
accepted:
12
03
2019
pubmed:
25
3
2019
medline:
14
1
2020
entrez:
25
3
2019
Statut:
ppublish
Résumé
Pedicle screw instrumentation is a standard procedure in lumbar spinal fusion. The cortical bone trajectory (CBT) screw is an alternative technique, less invasive but harder to perform. The identification of the entry point and the appropriate direction can be tricky especially to the surgeons just at the beginning. Therefore, the aim of this study is to evaluate the reliability of preoperative computed tomography (CT) planning in the CBT screw placement. We retrospectively evaluated 82 patients who underwent a single-level posterior lumbar arthrodesis with CBT screws. The correct entry point and the best trajectory were identified on a 3-dimensional (3D) multiplanar reconstruction CT view. The concordance between achieved and planned trajectories was assessed on a postoperative CT. A total of 328 screws was positioned. The average entry point distance from the target was 1.1 mm (standard deviation, ±0.15 mm). In 301 screws (91.8%), the obtained trajectory differed no more than 2° from the planned one. No screws misplaced or new neurological deficit was recorded. The CBT screw placement is a great alternative to the pedicle screw. Accurate preoperative 3D planning is useful to predict the entry point and the direction with accuracy similar to navigation systems, avoiding its costs and technical difficulties. The 3D CT planning is helpful in the customization of spine surgery, and the results underline the radiological reliability of this technique.
Sections du résumé
BACKGROUND
BACKGROUND
Pedicle screw instrumentation is a standard procedure in lumbar spinal fusion. The cortical bone trajectory (CBT) screw is an alternative technique, less invasive but harder to perform. The identification of the entry point and the appropriate direction can be tricky especially to the surgeons just at the beginning. Therefore, the aim of this study is to evaluate the reliability of preoperative computed tomography (CT) planning in the CBT screw placement.
METHODS
METHODS
We retrospectively evaluated 82 patients who underwent a single-level posterior lumbar arthrodesis with CBT screws. The correct entry point and the best trajectory were identified on a 3-dimensional (3D) multiplanar reconstruction CT view. The concordance between achieved and planned trajectories was assessed on a postoperative CT.
RESULTS
RESULTS
A total of 328 screws was positioned. The average entry point distance from the target was 1.1 mm (standard deviation, ±0.15 mm). In 301 screws (91.8%), the obtained trajectory differed no more than 2° from the planned one. No screws misplaced or new neurological deficit was recorded.
CONCLUSIONS
CONCLUSIONS
The CBT screw placement is a great alternative to the pedicle screw. Accurate preoperative 3D planning is useful to predict the entry point and the direction with accuracy similar to navigation systems, avoiding its costs and technical difficulties. The 3D CT planning is helpful in the customization of spine surgery, and the results underline the radiological reliability of this technique.
Identifiants
pubmed: 30904792
pii: S1878-8750(19)30799-5
doi: 10.1016/j.wneu.2019.03.121
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1468-e1474Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.