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How I do it? Lumbar cortical bone trajectory fixation with image-guided neuronavigation

  • How I Do it - Spine degenerative
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Abstract

Background

Cortical bone trajectory was described in 2009 to reduce screw loosening in osteoporotic patients. Since then, it has demonstrated improvements in biomechanical and perioperative results compared to pedicle screws, and it have been described as a minimally invasive technique.

Method

We describe our experience with the technique assisted by 3D neuronavigation and review some of the complications and tools to avoid them together with limitations and pitfalls.

Conclusion

Cortical bone trajectory guided by 3D neuronavigation helps to reduce the need for radiation and incidence of complications.

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University Hospital 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain

    Juan Delgado-Fernández

  2. Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain

    Paloma Pulido Rivas & Ricardo Gil-Simoes

  3. Director of UAM Chair “Innovation in Neurosurgery” Department of Neurosurgery, Hospital del Rosario, Universidad Autónoma de Madrid, Madrid, Spain

    Rafael García de Sola

Authors
  1. Juan Delgado-Fernández
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  2. Paloma Pulido Rivas
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  3. Ricardo Gil-Simoes
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  4. Rafael García de Sola
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Corresponding author

Correspondence to Juan Delgado-Fernández.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Key points

• Preoperative CT scan to measure pedicle diameter and grade of osteoporosis.

• Neuronavigation array is fixed with iliac crest pins.

• 3D fluoroscopy is obtained before opening, reducing the need for localization with radioscopy.

• Wound incision could be limited to 5–7 cm.

• Muscle dissection is limited to the lateral part of the pars without the need of transverse process exposure.

• Insertion point and path is described with the drill and neuronavigation probe with a medial to lateral and caudo-cephalad disposition.

• Use the tap to avoid widening of the path and avoid pedicle fracture.

• Guided-screws of at least 5.5mm diameter should be inserted to avoid breakage.

• Check correct positioning of screws with 3D fluoroscopy.

• Decompression of intervertebral space with laminectomy or hemilaminectomy before attachment of the screw head to the body.

This article is part of the Topical Collection on Spine degenerative

Electronic supplementary material

Demonstration of Neuronavigation set up and surgical procedure, showing intraoperative insertion point and screw implantation. (MP4 393,725 kb)

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Delgado-Fernández, J., Pulido Rivas, P., Gil-Simoes, R. et al. How I do it? Lumbar cortical bone trajectory fixation with image-guided neuronavigation. Acta Neurochir 161, 2423–2428 (2019). https://doi.org/10.1007/s00701-019-04067-0

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  • DOI: https://doi.org/10.1007/s00701-019-04067-0

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