Clinical and radiological features of cortical bone trajectory pedicle screw fixation of lumbar spine

Abstract

Background: Spinal fusion with pedicle screw fixation has become the gold standard of surgical treatment of degenerative conditions of the lumbar spine. The main drawback of this technique is its invasiveness associated with high complication rates. Consequently, a variety of minimally invasive spine procedures have been developed, the cortical bone trajectory (CBT) screw fixation being one of most promising. The study aimed to evaluate the imaging features, early clinical outcomes and complications of this new technique. Material and methods: The study included 38 patients who underwent spinal fusion with CBT pedicle screw fixation between January 2016 and January 2018. The mean follow-up after surgery was 6 months. Results: The surgical procedure included small midline laminectomy approach, bilateral facetectomy, unilateral or bilateral intervertebral cage insertion and navigation guided CBT pedicle screw fixation of the spine. Standing X-ray imaging was obtained prior to discharge and at three months after surgery. Follow-up CT scans at 1 year postoperatively were used to assess the fusion status. The mean blood loss, operation time and postoperative morbidity were significantly lower compared to traditional fusion techniques. Conclusions: The CBT approach is comparable to the traditional techniques in terms of successful fusion rates and clinical outcomes, but with additional benefits of less blood loss, less muscle damage and earlier functional recovery.