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Accuracy of cortical bone trajectory screw placement using patient-specific template guide system.

Keitaro Matsukawa1, Takashi Kaito2, Yuichiro Abe3

  • 1Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan. keitaro197897@hotmail.com.

Neurosurgical Review
|July 5, 2019
PubMed
Summary

Patient-specific guides improve accuracy for cortical bone trajectory (CBT) screw placement in spinal fusion. This technique ensures precise screw insertion, enhancing safety and reducing complications in minimally invasive surgery.

Keywords:
AccuracyCortical bone trajectoryLong trajectoryPatient-specific template guidePedicle screwScrew fixation

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Area of Science:

  • Spine Surgery
  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Cortical bone trajectory (CBT) offers minimally invasive screw fixation but requires high surgical skill due to narrow corridors.
  • Patient-specific template guides are a potential solution to enhance accuracy and safety in CBT screw placement.
  • Limited clinical data exists on the efficacy of CBT screw guides in surgical practice.

Purpose of the Study:

  • To evaluate the clinical accuracy and safety of CBT screw placement using a patient-specific template guide system.
  • To assess the feasibility of this technique for posterior lumbar spinal fusion.

Main Methods:

  • Retrospective analysis of 43 patients undergoing posterior lumbar spinal fusion using a custom CBT screw guide system.
  • Preoperative 3D planning using computer simulation software to define screw trajectories.
  • Postoperative computed tomography (CT) analysis of 198 screws (L1-L5) for pedicle perforation and deviation from planned trajectory.

Main Results:

  • 97.5% of screws (193/198) were placed entirely within the pedicle.
  • No neurovascular injuries were reported.
  • Mean screw deviations were minimal: 0.62 mm (coronal), 1.68° (sagittal), and 1.27° (transverse).

Conclusions:

  • Patient-specific template guides enable accurate CBT screw placement suitable for clinical application.
  • This technique facilitates correct screw insertion and may reduce surgical complications.
  • The guide system shows promise for improving outcomes in spinal fusion surgery.