Search Results

You are looking at 1 - 10 of 47 items for :

  • "cortical bone trajectory" x
Clear All
Full access

Masaki Ueno, Rina Sakai, Kensei Tanaka, Gen Inoue, Kentaro Uchida, Takayuki Imura, Wataru Saito, Toshiyuki Nakazawa, Naonobu Takahira, Kiyoshi Mabuchi and Masashi Takaso

fixation is achieved through insertion into cancellous bone. However, in elderly patients and others with osteoporosis, resorption of cancellous bone trabeculae may present problems with screw fixation, leading to development of such complications as loosening and displacement of screws. 2 , 3 , 5 , 6 A variety of techniques have been developed to address these problems, including the combined use of hooks and sublaminar wiring, and the use of hydroxyapatite sticks to fill pedicle screw holes. In 2009, Santoni et al. reported cortical bone trajectory (CBT) as a method

Full access

Jeffrey P. Mullin, Breanna Perlmutter, Eric Schmidt, Edward Benzel and Michael P. Steinmetz

P osterior spinal instrumentation has been used to achieve spinal fusion for decades. Currently, pedicle screw fixation using a “traditional” approach is the most common technique employed. This approach uses a trajectory that is along the axis of the pedicle with a cephalocaudad and lateral-to-medial trajectory. 15 , 18 In 2009, Santoni et al. described a novel technique of posterior instrumentation; this cortical bone trajectory (CBT) was described as a caudocephalad and medial-to-lateral trajectory. CBT instrumentation has been reported to be

Restricted access

Zachary Tan, Stewart McLachlin, Cari Whyne and Joel Finkelstein

ability to place pedicle screws safely is diminished. 15 Fluoroscopy and 3D navigation systems are commonly used for pedicle screw insertion and have been shown to improve the accuracy of placement of screws and reduce neurological complications. 8 , 11 , 17 The cortical bone trajectory (CBT) technique for lumbar instrumented fixation utilizes a more medialized start point, requires less lateral dissection, and enables a less invasive surgery (LIS) compared to the traditional pedicle screw technique. Initially described by Santoni et al., 19 the CBT technique follows

Restricted access

Keitaro Matsukawa, Yoshiyuki Yato, Takashi Kato, Hideaki Imabayashi, Takashi Asazuma and Koichi Nemoto

P edicle screws have become common and reliable instruments in treating a variety of spinal disorders. A cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory that was advocated by Santoni et al. in 2009. 24 The traditional technique of pedicle screw insertion uses a transpedicular path through the anatomical axis of the pedicle. In contrast, CBT follows a mediolaterally and caudocranially directed path through the pedicle and maximizes thread contact with the cortical bone surface, providing enhanced screw purchase. Biomechanical

Restricted access

Keitaro Matsukawa, Takashi Kato, Ralph Mobbs, Yoshiyuki Yato and Takashi Asazuma

., 5 allowing for the placement of longer and larger screws. 6 Compared with classic iliac screws, SAI screws are less prominent, requiring significantly reduced muscle dissection and showing superior biomechanical performance. 7 , 8 Some authors have reported the clinical outcomes using SAI screws, including lower rates of reoperation, surgical site infection, and symptomatic screw prominence. 9 , 10 Similar to this novel SI fixation technique, during the last decade, the cortical bone trajectory (CBT) showed increasing popularity as a new alternative to the

Full access

Keitaro Matsukawa, Yoshiyuki Yato, Hideaki Imabayashi, Naobumi Hosogane, Takashi Asazuma and Koichi Nemoto

studies, it has been recognized that variations in bone mineral density (BMD) within the vertebral body may have a major role in the biomechanical stiffness of the screw-bone interface. Recently, a novel lumbar pedicle screw path named the cortical bone trajectory (CBT) was advocated by Santoni et al. in 2009. 22 CBT follows a mediolaterally and caudocranially directed path through the pedicle and maximizes thread contact with the highest concentration of cortical bone. Additionally, screw insertion through a medial starting point offers advantages to avoid wide

Free access

Analiz Rodriguez, Matthew T. Neal, Ann Liu, Aravind Somasundaram, Wesley Hsu and Charles L. Branch Jr

portion of these patients will require reoperation to address symptomatic ASLD. 4 Subsequent operative intervention to treat ASLD usually includes decompression and fusion of adjacent spinal levels. During surgery for ASLD, it is not unusual to expose all of the preexisting hardware, which leads to significant pain and may potentially increase the risk of infection and need for perioperative blood transfusion. The cortical bone trajectory (CBT) technique can be used to avoid extensive tissue dissection by limiting the surgical corridor to the levels adjacent to the

Restricted access

Masaki Ueno, Takayuki Imura, Gen Inoue and Masashi Takaso

S antoni et al. recently reported on the use of a cortical bone trajectory (CBT) as a new insertion trajectory for pedicle screws. 12 Mechanical tests have shown that this trajectory provides greater pullout strength than does the traditional trajectory (TT). In patients with severe osteoporosis, however, it may not always be possible to achieve sufficient fixation strength solely with the CBT, and the initial fixation strength already obtained may be reduced by corrective operations. We performed posterior corrective fusion using a double

Restricted access

Ren-Jie Zhang, Hui-Min Li, Hai Gao, Chong-Yu Jia, Tao Xing, Fu-Long Dong and Cai-Liang Shen

used. 16 Cortical bone trajectory (CBT) screws follow a caudocephalad path sagittally and a lateral path transversally, thereby engaging only the cortical bone in a pedicle. These screws were recently developed as an alternative to TT screw fixation in the lumbar spine. According to biomechanical studies, CBT screws are equal to or better than TT screws in terms of pullout strength and toggle testing. 3 , 29 They also exhibit marked increases in pullout load compared with that of TT screws in the osteoporotic lumbar spine. 27 Another biomechanical analysis of CBT

Full access

Keitaro Matsukawa, Yoshiyuki Yato, Hideaki Imabayashi, Naobumi Hosogane, Takashi Asazuma and Kazuhiro Chiba

inserted using cortical bone trajectory (CBT), which was proposed by Santoni et al., 22 and those inserted using a traditional trajectory (TT). While CBT takes advantage of maximizing the engagement with cortical bone and provides enhanced screw purchase, 1 , 15 , 16 , 22 there is little consensus on the indication of CBT for patients with spondylolysis. Methods Finite Element Models The CT scans of 17 patients who underwent surgery for adult isthmic spondylolisthesis (mean amount of slippage 19.6% ± 4.2%) were used. There were 10 men and 7 women, with a mean