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Cortical Bone Trajectory for Thoracic Pedicle Screws: A Technical Note
Keitaro Matsukawa1, Yoshiyuki Yato, Richard A Hynes
1*Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama †Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan ‡Department of Engineering, Florida Institute of Technology, Melbourne, FL §Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Clinical Spine Surgery
|May 20, 2017
Summary
This study introduces a new thoracic cortical bone trajectory (CBT) for pedicle screws, enhancing bone engagement. The novel technique significantly increased screw insertional torque by 53.8% compared to traditional methods.
Area of Science:
- Spinal surgery
- Orthopedic biomechanics
- Surgical anatomy
Background:
- Cortical bone trajectory (CBT) offers superior screw purchase by maximizing thread contact with cortical bone.
- While CBT is used in the lumbar spine, a standardized insertional technique for the thoracic spine is lacking.
Purpose of the Study:
- To define a novel thoracic pedicle screw trajectory for optimal engagement with denser bone.
- To evaluate the morphometric parameters and biomechanical stability of this new trajectory.
Main Methods:
- Morphometric analysis of thoracic computed tomography scans (n=50) to determine optimal trajectory parameters.
- Biomechanical testing on cadaveric thoracic vertebrae (n=24) comparing insertional torque of the new CBT technique versus the traditional technique.
Main Results:
- Thoracic CBT morphometric parameters (diameter, length, cephalad angle) increased from T9 to T12.
- The novel CBT technique yielded a 53.8% greater mean insertional torque (1.02 Nm) compared to the traditional technique (0.66 Nm) (P<0.01).
Conclusions:
- The study successfully defined a thoracic cortical bone trajectory with favorable morphometric measurements.
- The novel thoracic CBT technique provides significantly enhanced screw fixation stability, as evidenced by increased insertional torque.
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