Marengo Nicola, Berjano Pedro, Cofano Fabio, Ajello Marco, Zenga Francesco, Pilloni Giulia, Penner Federica, Petrone Salvatore, Vay Lorenzo, Ducati Alessandro, Garbossa Diego
Section of Neurosurgery, Division of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
G Spine 4, IRCCS Orthopaedic Institute Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
Eur Spine J. 2018 Jun;27(Suppl 2):213-221. doi: 10.1007/s00586-018-5599-8. Epub 2018 Apr 16.
The use of cortical bone trajectory (CBT) pedicle screws for circumferential interbody fusion represents a viable alternative for single-level procedure with reduced invasiveness and less tissue destruction than the traditional technique. In addition, CBT screws have a potentially stronger pullout strength because of the greater amount of cortical bone intercepted. Only few series exist evaluating clinical and radiological outcomes of CBT screws.
This is a retrospective cohort study. All patients that underwent circumferential lumbar interbody fusion with CBT screws in our institution from 2014 to 2017 were reviewed. Patient demographics, clinical outcome with visual analogue scale (VAS) and Oswestry Disability Index (ODI), radiological data such as fusion, lordosis and muscle trauma, operative blood loss, hospital stay and use of fluoroscopy were evaluated.
A total of 101 patients undergoing CBT-arthrodesis for degenerative lumbo-sacral disease were reviewed. Mean procedural time was 187 min. The mean operative blood loss and X-ray dose per procedure was 383 ml and 1.60 mg cm, respectively. The mean hospital stay was 3.47 days. The mean follow-up was 18.23 months. Mean lordosis increment at the treated level was 4.2°. When the follow-up was longer than 12 months (53% of patients), fusion was obtained in 94% of cases. Mean ODI and VAS index improved with statistical significance.
This is to our knowledge that the largest available study regarding CBT for circumferential arthrodesis. Results underlined the safety of this technique and the promising clinical and radiological outcomes that will need a longer follow-up. These slides can be retrieved under Electronic Supplementary material.
使用皮质骨轨迹（CBT）椎弓根螺钉进行环形椎间融合术，是单节段手术的一种可行替代方案，与传统技术相比，其侵入性更小，组织破坏更少。此外，由于截获的皮质骨量更多，CBT螺钉具有潜在更强的拔出强度。仅有少数系列研究评估了CBT螺钉的临床和放射学结果。
这是一项回顾性队列研究。对2014年至2017年在本机构接受CBT螺钉环形腰椎椎间融合术的所有患者进行了回顾。评估了患者的人口统计学数据、视觉模拟量表（VAS）和奥斯威斯利功能障碍指数（ODI）的临床结果、融合、前凸和肌肉损伤等放射学数据、术中失血量、住院时间和透视的使用情况。
共回顾了101例因退行性腰骶部疾病接受CBT融合术的患者。平均手术时间为187分钟。每次手术的平均术中失血量和X线剂量分别为383毫升和1.60毫克·厘米。平均住院时间为3.47天。平均随访时间为18.23个月。治疗节段的平均前凸增加4.2°。当随访时间超过12个月时（53%的患者），94%的病例实现了融合。平均ODI和VAS指数有统计学意义的改善。
据我们所知，这是关于CBT用于环形融合术的最大规模现有研究。结果强调了该技术的安全性以及有前景的临床和放射学结果，不过仍需要更长时间的随访。这些幻灯片可在电子补充材料中获取。
