Sakaura Hironobu, Miwa Toshitada, Yamashita Tomoya, Kuroda Yusuke, Ohwada Tetsuo
1Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo; and.
2Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
J Neurosurg Spine. 2018 Jan;28(1):57-62. doi: 10.3171/2017.5.SPINE161154. Epub 2017 Nov 10.
OBJECTIVE The cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation. METHODS The study included 22 consecutively treated patients who underwent 2-level PLIF with CBT screw fixation for 2-level DS (CBT group, mean follow-up 39 months) and a historical control group of 20 consecutively treated patients who underwent 2-level PLIF using traditional PS fixation for 2-level DS (PS group, mean follow-up 35 months). Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Bony union was assessed by dynamic plain radiographs and CT images. Surgery-related complications, including symptomatic adjacent-segment disease (ASD), were examined. RESULTS The mean operative duration and intraoperative blood loss were 192 minutes and 495 ml in the CBT group and 218 minutes and 612 ml in the PS group, respectively (p < 0.05 and p > 0.05, respectively). The mean JOA score improved significantly from 12.3 points before surgery to 21.1 points (mean recovery rate 54.4%) at the latest follow-up in the CBT group and from 12.8 points before surgery to 20.4 points (mean recovery rate 51.8%) at the latest follow-up in the PS group (p > 0.05). Solid bony union was achieved at 90.9% of segments in the CBT group and 95.0% of segments in the PS group (p > 0.05). Symptomatic ASD developed in 2 patients in the CBT group (9.1%) and 4 patients in the PS group (20.0%, p > 0.05). CONCLUSIONS Two-level PLIF with CBT screw fixation for 2-level DS could be less invasive and result in improvement of clinical symptoms equal to those of 2-level PLIF using traditional PS fixation. The incidence of symptomatic ASD and the rate of bony union were lower in the CBT group than in the PS group, although these differences were not significant.
目的 皮质骨轨迹（CBT）螺钉技术是一种新型的非传统椎弓根螺钉（PS）置入方法。然而，多级CBT螺钉/棒固定的生物力学行为仍不清楚，且使用CBT螺钉固定进行二级腰椎后路椎间融合术（PLIF）后的手术效果尚未见报道。因此，本研究的目的是探讨使用CBT螺钉固定治疗二级退行性腰椎滑脱（DS）患者行二级PLIF后的临床和影像学结果，并将这些结果与使用传统PS固定进行二级PLIF后的结果进行比较。方法 本研究纳入22例连续接受二级PLIF并使用CBT螺钉固定治疗二级DS的患者（CBT组，平均随访39个月），以及一个历史对照组，该组有20例连续接受二级PLIF并使用传统PS固定治疗二级DS的患者（PS组，平均随访35个月）。使用日本骨科学会（JOA）评分系统评估临床症状。通过动态X线平片和CT图像评估骨融合情况。检查手术相关并发症，包括症状性相邻节段疾病（ASD）。结果 CBT组的平均手术时间和术中出血量分别为192分钟和495毫升，PS组分别为218分钟和612毫升（分别为p<0.05和p>0.05）。在CBT组，最新随访时JOA评分从术前的12.3分显著提高至21.1分（平均恢复率54.4%），在PS组，最新随访时从术前的12.8分提高至20.4分（平均恢复率51.8%）（p>0.05）。CBT组90.9%的节段实现了牢固的骨融合，PS组为95.0%（p>0.05）。CBT组有2例患者（9.1%）出现症状性ASD，PS组有4例患者（20.0%，p>0.05）。结论 对于二级DS患者，使用CBT螺钉固定进行二级PLIF可能创伤较小，临床症状改善情况与使用传统PS固定进行二级PLIF相当。CBT组症状性ASD的发生率和骨融合率低于PS组，尽管这些差异不显著。
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