Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis
Introduction: Cortical screws offer a less invasive alternative compared to traditional pedicle screws. These screws are inserted in an inferomedial to superolateral trajectory achieving greater cortical bone purchase. Similar fusion rates, pain relief, and decreased surgical morbidity at 12-month f...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920306125 |
| _version_ | 1818624522545266688 |
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| author | Reinier Alvarez Angel V. Chinea Alexander E. Braley Sonia Majid Kunal Patel Daniel Segui Amy K. Starosciak Sergio Gonzalez-Arias |
| author_facet | Reinier Alvarez Angel V. Chinea Alexander E. Braley Sonia Majid Kunal Patel Daniel Segui Amy K. Starosciak Sergio Gonzalez-Arias |
| author_sort | Reinier Alvarez |
| collection | DOAJ |
| description | Introduction: Cortical screws offer a less invasive alternative compared to traditional pedicle screws. These screws are inserted in an inferomedial to superolateral trajectory achieving greater cortical bone purchase. Similar fusion rates, pain relief, and decreased surgical morbidity at 12-month follow-up have been documented when compared to traditional pedicle screws. Using intra-operative imaging, neuronavigation, and individual neurophysiological monitoring of each screw, we showed that this is a safe surgical approach. Methods: Institutional review board (IRB) approved retrospective review of medical records for 173 patients to determine eligibility. Cases had to be elective one-or two-level fusion with surgical indication. Functional improvement was measured with Oswestry Disability Index (ODI) at pre and post-operative visits. Surgical morbidity data, individual screw thresholds, and radiographic evidence of stability was collected from electronic medical records (EMR). Results: A total of 153 patients met criteria with mean age 66.60 ± 9.30 (range: 34–84) and mean BMI of 28.76 ± 4.47 kg/m2. Of 558 screws inserted, no screws recorded <8 mA upon stimulation, thus no screw required repositioning. There were no pedicle or central canal breach related to screw insertion. ODI decreased from 44.83 ± 18.02 to 19.46 ± 19.52 at 3-months post-operative (p < 0.0001). A subset of 30 patients had 12-month post ODI, which showed a change from 41.22 ± 18.42 to 22.63 ± 22.01 at 12-months (p < 0.001). Conclusions: Within, we discuss our approach for inserting cortical screws in posterior lumbar fusion for patients with unstable degenerative lumbar spondylolisthesis. Our study shows that the implementation of intraoperative imaging, neuronavigation, and neurophysiological monitoring of individual screws can provide a safe environment for cortical screw insertion. This approach allows for a less invasive approach and greater quality bone purchase while mitigating the associated risks. |
| first_indexed | 2024-12-16T18:58:18Z |
| format | Article |
| id | doaj.art-17ddc5716eba4b67bc67cc28e6a1901d |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-16T18:58:18Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-17ddc5716eba4b67bc67cc28e6a1901d2022-12-21T22:20:28ZengElsevierInterdisciplinary Neurosurgery2214-75192021-06-0124101051Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesisReinier Alvarez0Angel V. Chinea1Alexander E. Braley2Sonia Majid3Kunal Patel4Daniel Segui5Amy K. Starosciak6Sergio Gonzalez-Arias7Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th St, AHC2 390W2, Miami, FL 33199, United States; Corresponding author.University of South Florida, Department of Neurosurgery and Brain Repair, 2 Tampa General Circle, Tampa, FL 33606, United StatesUpstate Medical University, Department of Neurosurgery, 750 E Adams Street, Syracuse, NY 13210, United StatesPenn State College of Medicine, Department of Neurosurgery, 500 University Drive, Hershey, PA 17033, United StatesBaptist Health South Florida, Miami Neuroscience Institute, 8900 North Kendall Drive, Miami, FL 33176, United StatesBaptist Health South Florida, Miami Neuroscience Institute, 8900 North Kendall Drive, Miami, FL 33176, United StatesFlorida International University, Herbert Wertheim College of Medicine, 11200 SW 8th St, AHC2 390W2, Miami, FL 33199, United States; Baptist Health South Florida, Miami Neuroscience Institute, 8900 North Kendall Drive, Miami, FL 33176, United StatesBaptist Health South Florida, Miami Neuroscience Institute, 8900 North Kendall Drive, Miami, FL 33176, United StatesIntroduction: Cortical screws offer a less invasive alternative compared to traditional pedicle screws. These screws are inserted in an inferomedial to superolateral trajectory achieving greater cortical bone purchase. Similar fusion rates, pain relief, and decreased surgical morbidity at 12-month follow-up have been documented when compared to traditional pedicle screws. Using intra-operative imaging, neuronavigation, and individual neurophysiological monitoring of each screw, we showed that this is a safe surgical approach. Methods: Institutional review board (IRB) approved retrospective review of medical records for 173 patients to determine eligibility. Cases had to be elective one-or two-level fusion with surgical indication. Functional improvement was measured with Oswestry Disability Index (ODI) at pre and post-operative visits. Surgical morbidity data, individual screw thresholds, and radiographic evidence of stability was collected from electronic medical records (EMR). Results: A total of 153 patients met criteria with mean age 66.60 ± 9.30 (range: 34–84) and mean BMI of 28.76 ± 4.47 kg/m2. Of 558 screws inserted, no screws recorded <8 mA upon stimulation, thus no screw required repositioning. There were no pedicle or central canal breach related to screw insertion. ODI decreased from 44.83 ± 18.02 to 19.46 ± 19.52 at 3-months post-operative (p < 0.0001). A subset of 30 patients had 12-month post ODI, which showed a change from 41.22 ± 18.42 to 22.63 ± 22.01 at 12-months (p < 0.001). Conclusions: Within, we discuss our approach for inserting cortical screws in posterior lumbar fusion for patients with unstable degenerative lumbar spondylolisthesis. Our study shows that the implementation of intraoperative imaging, neuronavigation, and neurophysiological monitoring of individual screws can provide a safe environment for cortical screw insertion. This approach allows for a less invasive approach and greater quality bone purchase while mitigating the associated risks.http://www.sciencedirect.com/science/article/pii/S2214751920306125SpondylolisthesisPosterior lumbar fusionCortical screwPedicle screwLumbar spine |
| spellingShingle | Reinier Alvarez Angel V. Chinea Alexander E. Braley Sonia Majid Kunal Patel Daniel Segui Amy K. Starosciak Sergio Gonzalez-Arias Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis Interdisciplinary Neurosurgery Spondylolisthesis Posterior lumbar fusion Cortical screw Pedicle screw Lumbar spine |
| title | Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| title_full | Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| title_fullStr | Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| title_full_unstemmed | Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| title_short | Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| title_sort | cortical screw fixation using ct navigation coupled with real time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis |
| topic | Spondylolisthesis Posterior lumbar fusion Cortical screw Pedicle screw Lumbar spine |
| url | http://www.sciencedirect.com/science/article/pii/S2214751920306125 |
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