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Related Experiment Video

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Cortical screw placement with a spinous process clamp guide: a cadaver study accessing accuracy.

Xi-Nuo Zhang1, Yi-Qi Zhang1, Yu-Zeng Liu1

  • 1Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Lu, Chaoyang District, Beijing, 100020, China.

BMC Surgery
|November 8, 2022
PubMed
Summary

The spinous process clip (SPC) guide ensures accurate placement of cortical bone trajectory (CBT) screws in the lumbar spine. This technique offers reliable execution for spinal fixation in osteoporotic patients.

Keywords:
Cadaveric studyCortical bone trajectoryGuideLumbar spine fixationNavigation

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Surgical techniques

Background:

  • Cortical bone trajectory (CBT) screw placement is an alternative fixation method for lumbar spine surgery, particularly in patients with osteoporosis.
  • Accurate CBT screw placement is crucial for enhancing mechanical stability and reducing complication rates.

Purpose of the Study:

  • To evaluate the accuracy of cortical screw placement using an implanted spinous process clip (SPC) guide.

Main Methods:

  • Four lumbar spine specimens (T12-S1) were used for accuracy assessment.
  • Preoperative planning and postoperative CT scans were used to compare planned versus inserted screws.
  • 3D-CT reconstructions evaluated screw accuracy using Gertzbein and Robbins classification.
  • Intraclass correlation coefficients (ICCs) and Bland-Altman plots assessed SPC-guided screw placement agreement.

Main Results:

  • All 48 planned screws achieved clinically acceptable trajectories (Grades A and B).
  • 93.8% of inserted screws were clinically acceptable, with no significant difference from planned screws (p=0.242).
  • Facet joint violation rates were low and comparable between planned (2.1%) and inserted screws (6.3%) (p=0.617).
  • Planned and inserted screw angles (lateral and cranial) were similar, demonstrating high reliability (p>0.66).

Conclusions:

  • The spinous process clip (SPC) guide enables reliable execution of cortical bone trajectory (CBT) screw placement.
  • The SPC guide facilitates accurate screw positioning, comparable to preoperative planning.