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Significance of the Pars Interarticularis in the Cortical Bone Trajectory Screw Technique: An In Vivo Insertional Torque Study
Asian Spine Journal ; : 901-906, 2016.
Article in English | WPRIM | ID: wpr-27908
ABSTRACT
STUDY

DESIGN:

Retrospective study.

PURPOSE:

Cortical bone trajectory (CBT), a more medial-to-lateral and shorter path than the traditional one for spinal fusion, is thought to be effective for severely degenerated vertebrae because screws are primarily stabilized at the posterior elements. We evaluated the efficacy of this approach through in vivo insertional torque measurement. OVERVIEW OF LITERATURE There has been only one prior in vivo study on CBT insertional torque.

METHODS:

Between January 2013 and April 2014, a total of 22 patients underwent posterior lumbar fusion using the CBT technique. The maximum insertional torque, which covers the radial strength needed for insertion, was measured for 113 screws, 8 of which were inserted for L5 spondylolysis. The insertional torque for cases with (n=8) and without (n=31) spondylolysis of L5 were compared using one-way analysis of variance (ANOVA). To evaluate vertebral degeneration, we classified 53 vertebrae without spondylolysis by lumbar radiography using semiquantitative methods; the insertional torque for the 105 screws used was compared on the basis of this classification. Additionally, differences in insertional torque among cases grouped by age, sex, and lumbar level were evaluated for these 105 screws using ANOVA and the Tukey test.

RESULTS:

The mean insertional torque was significantly lower for patients with spondylolysis than for those without spondylolysis (4.25 vs. 8.24 in-lb). There were no statistical differences in insertional torque according to vertebral grading or level. The only significant difference in insertional torque between age and sex groups was in men <75 years and women ≥75 years (10 vs. 5.5 in-lb).

CONCLUSIONS:

Although CBT should be used with great caution in patient with lysis who are ≥75 years, it is well suited for dealing with severely degenerated vertebrae because the pars interarticularis plays a very important role in the implementation of this technique.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Spinal Fusion / Spine / Spondylolysis / Radiography / Retrospective Studies / Classification / Torque Type of study: Diagnostic study / Observational study Limits: Female / Humans / Male Language: English Journal: Asian Spine Journal Year: 2016 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Spinal Fusion / Spine / Spondylolysis / Radiography / Retrospective Studies / Classification / Torque Type of study: Diagnostic study / Observational study Limits: Female / Humans / Male Language: English Journal: Asian Spine Journal Year: 2016 Type: Article