Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients

Chih-Chang Chang; Hsuan-Kan Chang; Chin-Chu Ko; Ching-Lan Wu; Yi-Hsuan Kuo; Tsung-Hsi Tu; Wen-Cheng Huang; Jau-Ching Wu

doi:10.14245/ns.2244888.444

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자료유형: 학술저널

저자정보: Chih-Chang Chang (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Hsuan-Kan Chang (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Chin-Chu Ko (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Ching-Lan Wu (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Yi-Hsuan Kuo (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Tsung-Hsi Tu (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Wen-Cheng Huang (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital) Jau-Ching Wu (Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital)

저널정보: 대한척추신경외과학회 Neurospine Neurospine 제20권 제1호

발행연도: 2023.3

수록면: 308 - 316 (9page)

DOI: 10.14245/ns.2244888.444

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Objective: Pedicle-based dynamic stabilization (DS) has gained popularity outside of Ameri ca. Although pedicle screw (PS) loosening has always been a concern, it is reportedly in nocuous. Cortical bone trajectory (CBT) screw is an emerging option with less invasiveness and similar effectiveness to PS in short-segment lumbar fusion. This study aimed to verify the use of CBT for DS by comparing the outcomes between pedicle- and CBT-based DS. Methods: Consecutive patients with lumbar spondylosis or low-grade spondylolisthesis who underwent 1- or 2-level DS between L3–5 with a minimum follow-up of 24 months were reviewed. Screw loosening was determined by computed tomography and the inci dences were compared. Results: A total of 291 patients who underwent Dynesys DS (235 pedicle- and 56 CBT-based, respectively) were compared. The demographics and preoperative conditions were similar. All the clinical outcomes improved at 24-month postoperation, while the CBT-based group had less operation time and blood loss than the pedicle-based group. The rates of screw loosening were lower in the CBT-based (5.4% per screw and 12.5% per patient) than the pedicle-based group (9% per screw and 26.4% per patient). Furthermore, there were no differences in the clinical outcomes and complication profiles. Conclusion: The CBT-based DS for 1- or 2-level lumbar degeneration demonstrated equiv alent clinical improvement as the pedicle-based DS. The adaption of CBT-based screws for DS could be a less invasive approach (shorter operation time and less blood loss), with low er chances of screw loosening than the conventional PS-based DS.

#Pedicle screw-based #Dynamic stabilization #Screw loosening #Cortical bone trajectory

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