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Fixation Strength of Caudal Pedicle Screws after Posterior Lumbar Interbody Fusion with the Modified Cortical Bone Trajectory Screw Method
Asian Spine Journal ; : 639-645, 2016.
Artículo en Inglés | WPRIM | ID: wpr-148235
ABSTRACT
STUDY

DESIGN:

Clinical case series.

PURPOSE:

In the posterior lumbar interbody fusion (PLIF) procedure in our institute, the cephalad screw trajectory follows a mediolateral and caudocephalad directed path according to the original cortical bone trajectory (CBT) method. However, the starting point of the caudal screw is at the medial border of the pedicle on an articular surface of the superior articular process, and the trajectory takes a mediolateral path parallel to the cephalad endplate. The incidence of caudal screw loosening after PLIF with this modified CBT screw method was investigated, and significant risk factors for caudal screw loosening were evaluated. OVERVIEW OF LITERATURE A biomechanical study of this modified caudal screw trajectory using the finite element method reported about a 20% increase in uniaxial yield pullout load compared with the traditional trajectory. However, there has been no clinical study concerning the fixation strength of this modified caudal screw trajectory.

METHODS:

The subjects were 193 consecutive patients who underwent single-level PLIF with modified CBT screw fixation. Caudal screw loosening was checked in computed tomography at 6 months after surgery, and screw loosening was defined as a radiolucency of 1 mm or more at the bone-screw interface.

RESULTS:

The incidence of caudal screw loosening after lumbosacral PLIF (46.2%) was significantly higher than that after floating PLIF (6.0%). No significant differences in sex, brand of the instruments, and diameter and length of the caudal screw were evident between patients with and without caudal screw loosening. Patients with caudal screw loosening were significantly older at the time of surgery than patients without caudal screw loosening.

CONCLUSIONS:

Fixation strength of the caudal screw after floating PLIF with this modified CBT screw technique was sufficiently acceptable. Fixation strength after the lumbosacral procedure was not.
Asunto(s)

Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Incidencia / Factores de Riesgo / Tornillos Pediculares / Estudio Clínico / Métodos Tipo de estudio: Estudio de etiología / Estudio de incidencia / Estudio pronóstico / Factores de riesgo Límite: Humanos Idioma: Inglés Revista: Asian Spine Journal Año: 2016 Tipo del documento: Artículo

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Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Incidencia / Factores de Riesgo / Tornillos Pediculares / Estudio Clínico / Métodos Tipo de estudio: Estudio de etiología / Estudio de incidencia / Estudio pronóstico / Factores de riesgo Límite: Humanos Idioma: Inglés Revista: Asian Spine Journal Año: 2016 Tipo del documento: Artículo