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  • Title: Accuracy and safety of cortical bone trajectory screw placement by an inexperienced surgeon using 3D patient-specific guides for transforaminal lumbar interbody fusion.
    Author: Maruo K, Arizumi F, Kusuyama K, Kishima K, Tachibana T.
    Journal: J Clin Neurosci; 2020 Aug; 78():147-152. PubMed ID: 32354646.
    Abstract:
    Cortical bone trajectory (CBT) is an alternative method for pedicle screw insertion. However, identification of the optimal entry point and the direction of the CBT can be challenging for less-experienced surgeons. The purpose of this study was to evaluate the accuracy of the CBT screw placement by an inexperienced surgeon using a three-dimensional (3D) patient-specific guide for transforaminal lumbar interbody fusion (TLIF). Retrospective analysis of the data pertaining to 30 patients (128 screws) who underwent TLIF with CBT by an inexperienced surgeon using a 3D patient-specific guide (MySpine MC, Medacta) at a single center was performed. The accuracy of the CBT screw was graded into four groups (no perforation; Grade A, 0-2 mm; Grade B, 2-4 mm; and Grade C, > 4 mm). The accuracy of the CBT screw placement was 91% (116/128). Out of the 12 misplaced screws, Grade A was observed in 7 screws (5%), Grade B was observed in 3 screws (2%), and Grade C was observed in 2 screws (2%). There were no cases of medial pedicle wall perforation. The mean screw size was 5.95 ± 0.34 mm in diameter and 40.15 ± 2.83 mm in length. Note that, the accuracy of the CBT screws increased to 97% (83/86) over the first10 cases. Preoperative planning and 3D patient-specific guide enabled the use of longer and thicker screws and an optimal entry point. These results suggest the possibility of efficacy and safety in using 3D patient-specific guides for CBT screw placement by an inexperienced surgeon.
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