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脳神経外科速報
Abstract
Objective: The pedicle screw fixation through the cortical bone trajectory(CBT) is a novel procedure of the pedicle screwing(PS) which follows a caudo-cephalad pathway in the sagittal plane and a medio-lateral pathway in the transverse plane. The advantage associated with this modified technique increases cortical bone contact, providing an enhancement of the screw stabilization. The avoidance of wide dissection of the superior facet joint and the paravertebral muscle allows to minimize approach-related trauma. However, little is known about the clinical applications of this promising procedure. We apply a minimally invasive spinal stabilization(MISS) to the CBT fixation in the present study. The authors describe the detail surgical procedure of MISS by the CBT for various lumbar degenerative disorders, and also mention a short-term surgical outcome. Patients and Methods: Fifteen patients with lumbar degenerative spondylolisthesis(LDS) and lumbar vertebral compression fracture(VCF) were included in this study between May 2012 and May 2013. We applied this procedure for the elderly patients of LDS with instability, the patients with consecutive instability of the adjacent facet joint after posterior lumbar interbody fusion and PS fixation, and the patients with VCF followed by a pseudoarthrosis. The mean age was 73 years old. The female / male ratio was 13 / 2. The mean follow-up period was 5.8 months. We evaluated clinical outcome using Japanese Orthopedic Association(JOA) scores. Results: The mean recovery rate by JOA scores was 39% for LDS and 33% for VCF. Conclusions: Surgical indication of spinal fusion by CBT is not different from that of conventional PS fixation, but less invasive and stronger fixation may be provided. Under the biplane C-arm fluoroscopic devices, we could detect the trajectory of the screws within the pedicles surely and in real time. As a result, there were no deviation examples of screws outside the pedicles. Especially in elderly patients, CBT-MISS for LDS with instability, the adjacent facet joint instability after previous spinal fusion, and delayed nervous disturbance due to VCF could be a therapeutic option to address the unstable spine. However, the long-term results are not yet given, and careful follow-up will be necessary in future.
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