Ivan Gonchar1, Yoshihisa Kotani1*, Yuki Matsui1, Takuji Miyazaki1 and Norimasa Iwasaki2
1Department of Orthopedic Surgery and Spine and Spinal Cord Center, Steel Memorial Muroran Hospital, Muroran, Japan
2Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Object: Percutaneous pedicle screws (PPS) have been widely used for posterior fusion. However, the osteoporotic spine in aging population leads to high rates of loosening. Recently introduced cortical bone trajectory (CBT) technique offers higher screw pullout strength and might be a solution to the problem. The aim of this study was to compare clinical outcomes of CBT vs. PPS in single level lumbar fusion.Methods: We retrospectively reviewed 30 patients who received single-level posterior lumbar fusion with PPS (mean age 65 y.o.) and 30 patients with CBT (mean age 64 years). The procedures included TLIF (transforaminal lumbar interbody fusion) for L3 to L5 spondylolisthesis. The clinical outcomes were assessed with Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Oswestry Disability Index (ODI) and VAS (visual analogue scale) scoring. We also evaluated the rates of nonunion and screw loosening.Results: There were no complications in both groups. The average operation time was significantly longer in the PPS group (p=0.02). The intraoperative blood loss was significantly greater in the PPS group (p=0.002). The average serum CRP (C - reactive protein) and CPK (creatine phosphokinase) level on POD1 (post-operative day 1) was significantly higher in the PPS group. The length of hospital stay was significantly longer for PPS group (p=0.03). Both groups showed significant improvement of JOABPEQ, ODI and VAS values at follow-up. The rate of screw loosening was statistically higher in the PPS group (p=0.009). Bony fusion rate was 90% in PPS group and 100% in CBT group (p=0.07).Conclusion: CBT proved to be less invasive and a stronger anchor in one level lumbar fusion for degenerative lumbar spine disease.
Gonchar I, Kotani Y, Matsui Y, Miyazaki T, Iwasaki N. Clinical Comparison of Cortical Bone Trajectory and Percutaneous Pedicle Screw in Single-Level Minimally Invasive Lumbar Fusion. Clin Surg. 2017; 2: 1568.