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Accuracy of cortical bone trajectory screw placement using patient-specific template guide system

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Abstract

Cortical bone trajectory (CBT) can facilitate both minimum invasiveness and strong screw fixation; however, ensuring the ideal cortical trajectory is challenging due to the narrow corridor, necessitating high-level surgical skill. A patient-specific template guide for CBT screw placement may be a promising solution to improve accuracy and safety. Little has been reported on the use of a CBT screw guide in clinical practice. The aim of the present study was to evaluate the accuracy of CBT screw placement using the template guide. This study was a retrospective clinical evaluation of prospectively collected patients. Forty-three consecutively enrolled patients who underwent posterior lumbar spinal fusion using the guide system were included. First, three-dimensional planning of CBT screw placement was performed using computer simulation software. The trajectory was directed in a more anterior position of the vertebral body, compared with the original CBT, and the standard size was set as 5–6 mm in diameter and 40–45 mm in length. Then, screw guides were created for each vertebra preoperatively and used. The safety and accuracy of a total of 198 inserted screws (L1 to L5) were analyzed using postoperative computed tomography by evaluation of pedicle perforation and measurement of screw deviations between the planned and actual screw positions. A total of 193 screws (97.5%) were placed completely inside the pedicle and there was no incidence of neurovascular injuries. The mean screw deviation from the planned trajectory on the coronal plane at the midpoint of the pedicle was 0.62 ± 0.42 mm, and the mean angular deviations in the sagittal and transverse planes were 1.68 ± 1.24° and 1.27 ± 0.77°, respectively. CBT screw placement using a patient-specific template guide was accurate enough for clinical application. This technique could be an effective solution to achieve both correct screw insertion and a reduction of complications.

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References

  1. Akpolat YT, İnceoğlu S, Kinne N, Hunt D, Cheng WK (2016) Fatigue performance of cortical bone trajectory screw compared with standard trajectory pedicle screw. Spine (Phila Pa 1976) 41:E335–E341

    Article  Google Scholar 

  2. Farshad M, Betz M, Farshad-Amacker NA, Moser M (2017) Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study. Eur Spine J 26:738–749

    Article  Google Scholar 

  3. He D, Yuan Q, Hu L, Tian W (2018) Robot assisted midline lumbar fusion with cortical bone trajectory screw. In: Zhan W, Rodriguez F, Baena Y (eds) CAOS 2018 (EPiC Series in Health Sciences) vol 2, pp 69–73

  4. Hung CW, Wu MF, Hong RT, Weng MJ, Yu GF, Kao CH (2016) Comparison of multifidus muscle atrophy after posterior lumbar interbody fusion with conventional and cortical bone trajectory. Clin Neurol Neurosurg 145:41–45

    Article  Google Scholar 

  5. Ishikawa T, Aramomi M (2015) Assessment of CBT screw insertion for posterior lumbar interbody fusion. J Spine Res 6:1071–1075

    Google Scholar 

  6. Kaito T, Matsukawa K, Abe Y, Fiechter M, Zhu X, Fantigrossi A (2018) Cortical pedicle screw placement in lumbar spine surgery with a patient-matched targeting guide: a cadaveric study. J Orthop Sci 23:865–869

    Article  Google Scholar 

  7. Kim SB, Rhee JM, Lee GS, Lee HY, Kim T, Won Y (2018) Computer-assisted patient-specific prototype template for thoracolumbar cortical bone trajectory screw placement: a cadaveric study. Tech Orthop 33:246–250

    Article  Google Scholar 

  8. Lamartina C, Cecchinato R, Fekete Z, Lipari A, Fiechter M, Berjano P (2015) Pedicle screw placement accuracy in thoracic and lumbar spinal surgery with a patient-matched targeting guide: a cadaveric study. Eur Spine J 24:937–941

    Article  Google Scholar 

  9. Lee GW, Son JH, Ahn MW, Kim HJ, Yeom JS (2015) The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial. Spine J 15:1519–1526

    Article  Google Scholar 

  10. Lu S, Xu YQ, Lu WW, Ni GX, Li YB, Shi JH, Li DP, Chen GP, Chen YB, Zhang YZ (2009) A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976) 34:E959–E966

    Article  Google Scholar 

  11. Marengo N, Berjano P, Cofano F, Ajello M, Zenga F, Pilloni G, Penner F, Petrone S, Vay L, Ducati A, Garbossa D (2018) Cortical bone trajectory screws for circumferential arthrodesis in lumbar degenerative spine: clinical and radiological outcomes of 101 cases. Eur Spine J 27:213–221

    Article  Google Scholar 

  12. Marengo N, Matsukawa K, Monticelli M, Ajello M, Pacca P, Cofano F, Penner F, Zenga F, Ducati A, Garbossa D (2019) Cortical bone trajectory screw placement accuracy with a patient-matched 3D printed guide in lumbar spinal surgery: a clinical study. World Neurosurg In press. https://doi.org/10.1016/j.wneu.2019.05.241

  13. Matsukawa K, Taguchi E, Yato Y, Imabayashi H, Hosogane N, Asazuma T, Nemoto K (2015) Evaluation of the fixation strength of pedicle screws using cortical bone trajectory: what is the ideal trajectory for optimal fixation? Spine (Phila Pa 1976) 40:E873–E878

    Article  Google Scholar 

  14. Matsukawa K, Kato T, Yato Y, Sasao H, Imabayashi H, Hosogane N, Asazuma T, Chiba K (2016) Incidence and risk factors of adjacent cranial facet violation following pedicle screw insertion using cortical bone trajectory technique. Spine (Phila Pa 1976) 41:E851–E856

    Article  Google Scholar 

  15. Matsukawa K, Yato Y, Imabayashi H, Hosogane N, Abe Y, Asazuma T, Chiba K (2016) Biomechanical evaluation of fixation strength among different sizes of pedicle screws using the cortical bone trajectory: what is the ideal screw size for optimal fixation? Acta Neurochir 158:465–471

    Article  Google Scholar 

  16. McKinley TO, McLain RF, Yerby SA, Sharkey NA, Sarigul-Klijn N, Smith TS (1999) Characteristics of pedicle screw loading: effect of surgical technique on intravertebral and intrapedicular bending moments. Spine (Phila Pa 1976) 24:18–25

    Article  CAS  Google Scholar 

  17. Mobbs RJ (2013) The “medio-latero-superior trajectory technique”: an alternative cortical trajectory for pedicle fixation. Orthop Surg 5:56–59

    Article  Google Scholar 

  18. Perez-Orribo L, Kalb S, Reyes PM, Chang SW, Crawford NR (2013) Biomechanics of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. Spine (Phila Pa 1976) 38:635–641

    Article  Google Scholar 

  19. Sakaura H, Miwa T, Yamashita T, Kuroda Y, Ohwada T (2016) Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study. J Neurosurg Spine 25:591–595

    Article  Google Scholar 

  20. Sakaura H, Ohnishi A, Yamagishi A, Ohwada T (2018) Early fusion status after posterior lumbar interbody fusion with cortical bone trajectory screw fixation: a comparison of titanium-coated polyetheretherketone cages and carbon polyetheretherketone cages. Asian Spine J. https://doi.org/10.31616/asj.2018.0169

  21. Santoni BG, Hynes RA, McGilvary KC, Rodriguez-Canessa G, Lyons AS, Henson MA, Womack WJ, Puttlitz CM (2009) Cortical bone trajectory for lumbar pedicle screws. Spine J 9:366–373

    Article  CAS  Google Scholar 

  22. Sugawara T, Higashiyama N, Kaneyama S, Takabatake M, Watanabe N, Uchida F, Sumi M, Mizoi K (2013) Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article. J Neurosurg Spine 19:185–190

    Article  Google Scholar 

  23. Takemoto M, Fujibayashi S, Ota E, Otsuki B, Kimura H, Sakamoto T, Kawai T, Futami T, Sasaki K, Matsushita T, Nakamura T, Neo M, Matsuda S (2016) Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area. Eur Spine J 25:1698–1705

    Article  Google Scholar 

  24. Takenaka S, Mukai Y, Tateishi K, Hosono N, Fuji T, Kaito T (2017) Clinical outcomes after posterior lumbar interbody fusion: comparison of cortical bone trajectory and conventional pedicle screw insertion. Clin Spine Surg 30:E1411–E1418

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Meinrad Fiechter and Kris Chavatte for their support during customizing guide design.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan

    Keitaro Matsukawa

  2. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Takashi Kaito

  3. Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido, Japan

    Yuichiro Abe

Authors
  1. Keitaro Matsukawa
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  2. Takashi Kaito
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  3. Yuichiro Abe
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Correspondence to Keitaro Matsukawa.

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The authors are consultants for Medacta.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional (National Hospital Organization, Murayama Medical Center) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

The manuscript submitted does not contain information about medical device(s)/drug(s).

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Matsukawa, K., Kaito, T. & Abe, Y. Accuracy of cortical bone trajectory screw placement using patient-specific template guide system. Neurosurg Rev 43, 1135–1142 (2020). https://doi.org/10.1007/s10143-019-01140-1

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  • DOI: https://doi.org/10.1007/s10143-019-01140-1

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