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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Laminectomy | Research article

Minimally invasive dynamic screw stabilization using cortical bone trajectory

Authors: Chih-Chang Chang, Chao-Hung Kuo, Hsuan-Kan Chang, Tsung-Hsi Tu, Li-Yu Fay, Jau-Ching Wu, Henrich Cheng, Wen-Cheng Huang

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

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Abstract

Background

The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series.

Methods

The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated.

Results

A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients’ back and leg pain improved significantly after the surgery.

Conclusion

This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.
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Metadata
Title
Minimally invasive dynamic screw stabilization using cortical bone trajectory
Authors
Chih-Chang Chang
Chao-Hung Kuo
Hsuan-Kan Chang
Tsung-Hsi Tu
Li-Yu Fay
Jau-Ching Wu
Henrich Cheng
Wen-Cheng Huang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03629-z

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