Freehand screw insertion technique without image guidance for the cortical bone trajectory screw in posterior lumbar interbody fusion: what affects screw misplacement?

Objective: Cortical bone trajectory (CBT) screw insertion using a freehand technique is considered less feasible than guided techniques, due to the lack of readily identifiable visual landmarks. However, in posterior lumbar interbody fusion (PLIF), after resection of the posterior anatomy, the pedicles themselves, into which implantation is performed, are palpable from the spinal canal and neural foramen. With the help of pedicle wall probing, the authors have placed CBT screws using a freehand technique without image guidance in PLIF.

Impacts of postoperative changes of segmental mobility on neurological improvement after laminoplasty for cervical ossification of the posterior longitudinal ligament.

Several studies have demonstrated that the dynamic factor at the mobile segment affects the severity of myelopathy in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL), and posterior decompression supplemented with posterior instrumented fusion at the mobile segment provides good neurological improvement. However, there have been few reports of changes in range of motion at the mobile segment (segmental ROM) after laminoplasty (LP). The aim of this study was thus to retrospectively investigate changes in segmental ROM after LP and the impacts of these changes on neurological improvement in patients with C-OPLL.

Postoperative Loss of Lumbar Lordosis Affects Clinical Outcomes in Patients with Pseudoarthrosis after Posterior Lumbar Interbody Fusion Using Cortical Bone Trajectory Screw Fixation.

Study Design: Retrospective cohort study.

Purpose: This study aimed to investigate relationships between clinical outcomes and radiographic parameters in patients with pseudoarthrosis after posterior lumbar interbody fusion (PLIF).

Overview Of Literature: In some patients with pseudoarthrosis after PLIF, clinical symptoms improve following surgery, although pseudoarthrosis can often be one of the complications.

Differences in Postoperative Changes of Cervical Sagittal Alignment and Balance After Laminoplasty Between Cervical Spondylotic Myelopathy and Cervical Ossification of the Posterior Longitudinal Ligament.

Study Design: Retrospective cohort study.

Objectives: To compare postoperative changes of cervical sagittal alignment (CSA) and cervical sagittal balance (CSB) after laminoplasty between cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to examine impacts of these radiologic changes on neurologic outcomes.

Methods: A total of 168 consecutive patients with CSM (CSM group) and 51 consecutive patients with OPLL (OPLL group) were included.

Early Fusion Status after Posterior Lumbar Interbody Fusion with Cortical Bone Trajectory Screw Fixation: A Comparison of Titanium-Coated Polyetheretherketone Cages and Carbon Polyetheretherketone Cages.

Study Design: Retrospective cohort study.

Purpose: We recently reported that when compared to posterior lumbar interbody fusion (PLIF) using traditional pedicle screw fixation, PLIF with cortical bone trajectory screw fixation (CBT-PLIF) provided favorable clinical outcomes and reduced the incidence of symptomatic adjacent segment pathology, but resulted in relatively lower fusion rates. Since titanium-coated polyetheretherketone (PEEK) cages (TP) could improve and accelerate fusion status after CBT-PLIF, early fusion status was compared between CBT-PLIF using TP and carbon PEEK cages (CP).

Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis.

OBJECTIVE The cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation.

Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study.

OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation.

Fixation Strength of Caudal Pedicle Screws after Posterior Lumbar Interbody Fusion with the Modified Cortical Bone Trajectory Screw Method.

Study Design: Clinical case series.

Purpose: In the posterior lumbar interbody fusion (PLIF) procedure in our institute, the cephalad screw trajectory follows a mediolateral and caudocephalad directed path according to the original cortical bone trajectory (CBT) method. However, the starting point of the caudal screw is at the medial border of the pedicle on an articular surface of the superior articular process, and the trajectory takes a mediolateral path parallel to the cephalad endplate.

Surgical outcomes after laminoplasty for cervical spondylotic myelopathy in patients with renal dysfunction and/or aortic arch calcification.

OBJECTIVE The authors recently reported that the presence of chronic kidney disease (CKD) and/or extended abdominal aortic calcification was associated with significantly worse clinical outcomes after posterior lumbar interbody fusion. CKD is one of the highest risk factors for systemic atherosclerosis. Therefore, impaired blood flow due to atherosclerosis could exacerbate degeneration of the cervical spine and neural tissue.

Incidence and Risk Factors for Late Neurologic Deterioration after C3-C6 Laminoplasty for Cervical Spondylotic Myelopathy.

Study Design Retrospective study. Objective We previously reported that the long-term neurologic outcomes of C3-C6 laminoplasty for cervical spondylotic myelopathy (CSM) are satisfactory, with reduced frequencies of postoperative axial neck pain and kyphotic deformity. However, only 20 patients were included, which is a limitation in that study.

Lifestyle-Related Diseases Affect Surgical Outcomes after Posterior Lumbar Interbody Fusion.

Study Design Retrospective study. Objective Hyperlipidemia (HL) and hypertension (HT) lead to systemic atherosclerosis. Not only atherosclerosis but also bone fragility and/or low bone mineral density result from diabetes mellitus (DM) and chronic kidney disease (CKD).

Modified posterior lumbar interbody fusion for radiculopathy following healed vertebral collapse of the middle-lower lumbar spine.

Study Design Retrospective study. Objectives Lumbar radiculopathy is rarely observed in patients who have achieved bony healing of vertebral fractures in the middle-lower lumbar spine. The objectives of the study were to clarify the clinical features of such radiculopathy and to evaluate the preliminary outcomes of treatment using a modified posterior lumbar interbody fusion (PLIF) procedure.

Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits.

Surgical treatment of osteoporotic vertebral collapse (OVC) with neurological deficits presents significant clinical challenges because some patients have fragile bones and often have medical comorbidities, which affect the severity of osteoporosis. We hypothesized that clinical results of surgery in these patients depend on the extent of medical comorbidities that induce secondary osteoporosis. The aim of this study is to examine the effects of medical history and comorbidities on surgical outcomes for these patients, along with the factors that predict postoperative function in activities of daily living (ADL).

Symptomatic adjacent segment pathology after posterior lumbar interbody fusion for adult low-grade isthmic spondylolisthesis.

The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified significant risk factors for symptomatic ASP.

Postoperative deep surgical-site infection after instrumented spinal surgery: a multicenter study.

A retrospective survey revealed 37 cases (1.1%) of deep surgical-site infection (SSI) among 3,462 instrumented spinal surgeries between 2004 and 2008. Excluding 8 patients who were unclassifiable, we categorized 29 patients into 3 groups of similar backgrounds-thoracolumbar degenerative disease (the DEG group; n = 15), osteoporotic vertebral collapse (the OVC group; n = 10), and cervical disorders (the cervical group; n = 4)-and investigated the key to implant salvage.

Cervical myelopathy caused by invagination of anomalous lamina of the axis.

The authors report a case of cervical myelopathy caused by invagination of the bilaterally separated lamina of the axis. They also present a literature review. The patient was a previously healthy 68-year-old man with a 1-year history of slowly progressive gait disturbance, right-hand clumsiness, and right dominant sensory disturbance in his trunk and extremities.

Steroid-induced paraparesis: spinal epidural lipomatosis complicated by a wedge deformity of the middle thoracic vertebrae.

Steroid therapy is commonly prescribed, although a variety of complications have been reported. Among such complications, spinal epidural lipomatosis is rare and difficult to diagnose before paraparesis occurs. The purpose of this report is to present a rare but catastrophic complication of steroid therapy.

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.

Purpose: Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD.

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis.

Object: A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues.

Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures--anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty.

Purpose: In general, osteoporotic vertebral collapse (OVC) with neurological deficits requires sufficient decompression of neural tissues to restore function level in activities of daily living (ADL). However, it remains unclear as to which procedure provides better neurological recovery. The primary purpose of this study was to compare neurological recovery among three typical procedures for OVC with neurological deficits.

Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery.

Object: Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%-3%.

Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF.

Study Design: A retrospective case-control study.

Objective: To clarify associations between both lamina horizontalization and facet tropism and adjacent segment degeneration (ASD).

Summary Of Background Data: We have previously reported coexistence of lamina horizontalization and facet tropism adjacent to the cranial fusion segment as risk factors for ASD.

Surgical outcome of drop foot caused by degenerative lumbar diseases.

Study Design: A total of 46 patients undergoing lumbar spine surgery for degenerative lumbar disease and presenting with drop foot were included in this retrospective study.

Objective: To determine which preoperative patients' symptoms were of statistical significance in their effect on surgical outcome.

Summary Of Background Data: Drop foot is a neuromuscular condition that results in palsy of the ankle dorsiflexion and is a major problem in Japanese daily life.

Indication of posterior lumbar interbody fusion for lumbar disc herniation.

Objective: To examine whether lumbar disc herniation with massive extrusion and/or segmental instability can be an indicator for spinal fusion or not, by comparing the outcome of posterior lumbar interbody fusion (PLIF) and discectomy alone.

Methods: One hundred seventy-four patients with PLIF and 177 patients with discectomy were retrospectively analyzed. We hypothesized two criteria for fusion: massive herniation and segmental instability.