Wochna Jacob C, Marciano Rudy, Catanescu Irina, Katz Joel, Spalding M Chance, Narayan Kailash
Medical Student, Ohio University Heritage College of Osteopathic Medicine, Athens, USA.
Neurological Surgery, OhioHealth, Columbus, USA.
Cureus. 2018 Jun 28;10(6):e2891. doi: 10.7759/cureus.2891.
Objective Cortical bone trajectory pedicle screws (CBT) have a different trajectory compared to traditional pedicle screws (PS) and they may confer biomechanical advantages in some patient populations. We hypothesize that the placement of CBT in traumatic thoracolumbar fractures could be an alternative technique to the traditional utilization of PS. Methods Single surgeon, retrospective study was performed at a Level 1 Trauma Center from 2013 to 2017. All patients aged between 18 and 90 years with operative AO classification A, B, and C traumatic thoracolumbar fractures were included. Patients with pathological fractures, active spinal infections, or history of vertebral augmentation were excluded. Age, injury severity score (ISS), AO classification, operative time, estimated blood loss (EBL), length of stay (LOS), and presence of proximal junctional kyphosis (PJK) or construct failure were compared between CBT and PS groups. The PS group was further separated into open reduction internal fixation (ORIF) and minimally invasive spine (MIS) groups. All CBT and ORIF cases were completed via open incisions allowing arthrodesis of the involved lamina and facet joints whereas no arthrodesis was completed in the MIS patients. Choice of technique was at the attending surgeon's discretion. Results The study included 71 patients, out of which 12 received CBT and 59 received PS. Of the 59 PS patients, 39 were ORIF and 20 were MIS. The average operative time was 22.9 minutes less in CBT compared to ORIF (p = 0.24). EBL was 337.50 mL for CBT, 184.33 mL for MIS, and 503.33 mL for ORIF (p = 0.01) demonstrating that MIS technique results in a significantly reduced blood loss. However, EBL was comparable for CBT versus MIS (p > 0.05). ISS was not significantly different between the three groups (p = 0.89). LOS was 4.06 days fewer for CBT patients compared to ORIF patients (p = 0.36). There was one case of construct failure as well as one case of incisional site infection in the PS group, but none were found in the CBT group. Instances of PJK complications were determined by the change in the Cobb angle over time and they were not statistically different between the three groups (p = 0.68). Conclusions CBT is noninferior to PS in the fixation of unstable adult traumatic thoracolumbar fractures. With the exception of EBL, CBT was not statistically different compared to MIS and ORIF. This study establishes a precedent to expand the application of this new technique and investigate with larger sample sizes.
目的 皮质骨轨迹椎弓根螺钉（CBT）与传统椎弓根螺钉（PS）的轨迹不同，在某些患者群体中可能具有生物力学优势。我们假设在创伤性胸腰椎骨折中置入CBT可能是传统PS应用的一种替代技术。方法 于2013年至2017年在一级创伤中心进行了单术者回顾性研究。纳入所有年龄在18至90岁之间、手术AO分类为A、B和C型的创伤性胸腰椎骨折患者。排除病理性骨折、活动性脊柱感染或有椎体强化史的患者。比较CBT组和PS组之间的年龄、损伤严重程度评分（ISS）、AO分类、手术时间、估计失血量（EBL）、住院时间（LOS）以及近端交界性后凸（PJK）或内固定失败的情况。PS组进一步分为切开复位内固定（ORIF）组和微创脊柱（MIS）组。所有CBT和ORIF病例均通过开放切口完成，允许对受累椎板和小关节进行融合，而MIS患者未进行融合。技术选择由主刀医生自行决定。结果 该研究共纳入71例患者，其中12例接受CBT，59例接受PS。在59例PS患者中，39例为ORIF，20例为MIS。与ORIF相比，CBT的平均手术时间少22.9分钟（p = 0.24）。CBT的EBL为337.50 mL，MIS为184.33 mL，ORIF为503.33 mL（p = 0.01），表明MIS技术导致失血量显著减少。然而，CBT与MIS的EBL相当（p > 0.05）。三组之间的ISS无显著差异（p = 0.89）。CBT患者较ORIF患者的LOS少4.06天（p = 0.36）。PS组有1例内固定失败和1例切口部位感染，但CBT组未发现。PJK并发症的情况通过Cobb角随时间的变化来确定，三组之间无统计学差异（p = 0.68）。结论 在不稳定的成人创伤性胸腰椎骨折固定中，CBT不劣于PS。除EBL外，CBT与MIS和ORIF相比无统计学差异。本研究为扩大这项新技术的应用并进行更大样本量的研究开创了先例。
