scholarly journals Biomechanical Evaluation of Cross Trajectory Technique for Pedicle Screw Insertion: Combined Use of Traditional Trajectory and Cortical Bone Trajectory

2015 ◽  
Vol 7 (4) ◽  
pp. 317-323 ◽  
Author(s):  
Keitaro Matsukawa ◽  
Yoshiyuki Yato ◽  
Hideaki Imabayashi ◽  
Naobumi Hosogane ◽  
Takashi Asazuma ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Combined Use ◽  
Biomechanical Evaluation

Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Spine ◽  
2016 ◽  
Vol 41 (14) ◽  
pp. E851-E856 ◽  
Author(s):  
Keitaro Matsukawa ◽  
Takashi Kato ◽  
Yoshiyuki Yato ◽  
Hiroshi Sasao ◽  
Hideaki Imabayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Facet Joint Violation

Morphometric Measurement of Cortical Bone Trajectory for Lumbar Pedicle Screw Insertion Using Computed Tomography

2013 ◽  
Vol 26 (6) ◽  
pp. E248-E253 ◽  
Author(s):  
Keitaro Matsukawa ◽  
Yoshiyuki Yato ◽  
Osamu Nemoto ◽  
Hideaki Imabayashi ◽  
Takashi Asazuma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Morphometric Measurement ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Lumbar Pedicle

scholarly journals Isthmus-guided Cortical Bone Trajectory for Pedicle Screw Insertion

2014 ◽  
Vol 6 (3) ◽  
pp. 244-248 ◽  
Author(s):  
Koichi Iwatsuki ◽  
Toshiki Yoshimine ◽  
Yu-ichiro Ohnishi ◽  
Kosi Ninomiya ◽  
Toshika Ohkawa
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

The Cortical Bone Trajectory for Pedicle Screw Insertion

JBJS Reviews ◽  
2017 ◽  
Vol 5 (8) ◽  
pp. e13 ◽  
Author(s):  
I. David Kaye ◽  
Srinivas K. Prasad ◽  
Alex R. Vaccaro ◽  
Alan S. Hilibrand
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

Robot-Assisted Cortical Bone Trajectory Insertion of Pedicle Screws: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E171-E171
Author(s):  
Justice O Agyei ◽  
Asham Khan ◽  
Patrick K Jowdy ◽  
Timothy E O’Connor ◽  
Joshua E Meyers ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Degrees Of Freedom ◽  
Pedicle Screws ◽  
Complication Rates ◽  
Robot Assisted ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
6 Degrees Of Freedom

Abstract Robot-assisted pedicle screw insertion has been slowly gaining popularity in the spine surgery community. In previous studies, robotics has been shown to increase accuracy and reduce complication rates compared to other navigation technologies, although those studies have been conducted using traditional trajectories for pedicle screw insertion. We present a surgical video in which a robotics system (Mazor X; Mazor Robotics Ltd, Caesarea, Israel) was used to create cortical bone trajectories for the insertion of the screws. The patient in this case is a 52-yr-old woman with severe L4-5 disc herniation requiring a transforaminal interbody fusion with the insertion of pedicle screws. The robotic system's scan-and-plan technique was utilized, in which an intraoperative computed tomography (CT) scan generates a real-time operative plan. Other techniques for inserting pedicle screws using cortical bone trajectories include CT navigation and fluoroscopic guidance. These techniques allow the surgeon to manually direct the screw under precise guidance in multiple planes, although the surgeon is still using all 6 degrees of freedom the human hand provides. With robotic guidance, a pilot hole is drilled, which eliminates 4 of 6 degrees of freedom, which can potentially reduce the risk of misplaced screws. To our knowledge, this is the first video demonstrating pedicle screw insertion through cortical bone trajectories using robotic guidance. Future studies are warranted to compare cortical bone trajectory insertion using different navigation techniques to determine the long-term efficacy of each technique. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.

scholarly journals Minimally invasive dynamic screw stabilization using cortical bone trajectory

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Chih-Chang Chang ◽  
Chao-Hung Kuo ◽  
Hsuan-Kan Chang ◽  
Tsung-Hsi Tu ◽  
Li-Yu Fay ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Case Series ◽  
Dynamic Stabilization ◽  
Low Grade ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Soft Tissue Dissection ◽  
Spinal Navigation

Abstract Background The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. Methods The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. Results A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients’ back and leg pain improved significantly after the surgery. Conclusion This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.

Validation of a freehand technique for cortical bone trajectory screws in the lumbar spine

2019 ◽  
Vol 31 (2) ◽  
pp. 201-208 ◽  
Author(s):  
Zachary Tan ◽  
Stewart McLachlin ◽  
Cari Whyne ◽  
Joel Finkelstein
Keyword(s):  
Lumbar Spine ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Ex Vivo ◽  
Screw Placement ◽  
Anatomical Landmarks ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Freehand Technique ◽  
Ex Vivo Study

OBJECTIVEThe cortical bone trajectory (CBT) technique for pedicle screw placement has gained popularity among spinal surgeons. It has been shown biomechanically to provide better fixation and improved pullout strength compared to a traditional pedicle screw trajectory. The CBT technique also allows for a less invasive approach for fusion and may have lower incidence of adjacent-level disease. A limitation of the current CBT technique is a lack of readily identifiable and reproducible visual landmarks to guide freehand CBT screw placement in comparison to the well-defined identifiable landmarks for traditional pedicle screw insertion. The goal of this study was to validate a safe and intuitive freehand technique for placement of CBT screws based on optimization of virtual CBT screw placement using anatomical landmarks in the lumbar spine. The authors hypothesized that virtual identification of anatomical landmarks on 3D models of the lumbar spine generated from CT scans would translate to a safe intraoperative freehand technique.METHODSCustomized, open-source medical imaging and visualization software (3D Slicer) was used in this study to develop a workflow for virtual simulation of lumbar CBT screw insertion. First, in an ex vivo study, 20 anonymous CT image series of normal and degenerative lumbar spines and virtual screw insertion were conducted to place CBT screws bilaterally in the L1–5 vertebrae for each image volume. The optimal safe CBT trajectory was created by maximizing both the screw length and the cortical bone contact with the screw. Easily identifiable anatomical surface landmarks for the start point and trajectory that best allowed the reproducible idealized screw position were determined. An in vivo validation of the determined landmarks from the ex vivo study was then performed in 10 patients. Placement of virtual “test” cortical bone trajectory screws was simulated with the surgeon blinded to the real-time image-guided navigation, and the placement was evaluated. The surgeon then placed the definitive screw using image guidance.RESULTSFrom the ex vivo study, the optimized technique and landmarks were similar in the L1–4 vertebrae, whereas the L5 optimized technique was distinct. The in vivo validation yielded ideal, safe, and unsafe screws in 62%, 16%, and 22% of cases, respectively. A common reason for the nonidealized trajectories was the obscuration of patient anatomy secondary to severe degenerative changes.CONCLUSIONSCBT screws were placed ideally or safely 78% of the time in a virtual simulation model. A 22% rate of unsafe freehand trajectories suggests that the CBT technique requires use of image-guided navigation or x-ray guidance and that reliable freehand CBT screw insertion based on anatomical landmarks is not reliably feasible in the lumbar spine.

Biomechanical Evaluation of the Pedicle Screw Insertion Depth Effect on Screw Stability Under Cyclic Loading and Subsequent Pullout

2015 ◽  
Vol 28 (3) ◽  
pp. E133-E139 ◽  
Author(s):  
Kristophe J. Karami ◽  
Laura E. Buckenmeyer ◽  
Ata M. Kiapour ◽  
Prashant S. Kelkar ◽  
Vijay K. Goel ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Pedicle Screw ◽  
Insertion Depth ◽  
Depth Effect ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Biomechanical Evaluation
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