Minimally invasive dynamic screw stabilization using cortical bone trajectory
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(2020) 21:605
RESEARCH ARTICLE
Open Access
Minimally invasive dynamic screw stabilization using cortical bone trajectory Chih-Chang Chang1,2,3, Chao-Hung Kuo1,2,3, Hsuan-Kan Chang1,2, Tsung-Hsi Tu1,2, Li-Yu Fay1,2, Jau-Ching Wu1,2, Henrich Cheng1,2,4 and Wen-Cheng Huang1,2*
Abstract Background: The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. Methods: The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. Results: A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients’ back and leg pain improved significantly after the surgery. Conclusion: This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach. Keywords: Minimally invasive spine surgery, Spondylolisthesis, Dynamic stabilization, Cortical bone trajectory (CBT)
Background Various fusion techniques have been accepted as the surgical management for disc degenerative disease or spondylolisthesis, including anterior, posterior, transforaminal, and extreme lateral lumbar interbody fusion (ALIF, PLIF, TLIF and LLIF) [1–4]. In the past decade there has been an emerging option of dynamic stabilization to treat low-grade degenerative disease. The design concept of dynamic stabilization is to ameliorate * Correspondence: [email protected] 1 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan Full list of author information is available at the end of the article
the instability while maintaining segmental motility, thus yielding the potential for the prevention of adjacent segment disease (ASD). Although the actual benefit in the reduction of ASD remains elusive, more and more reports have demonstrated that dynamic stabilization is a viable option for degenerative disease o
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