MORPHOMETRY OF THE POSITIONING OF CORTICAL TRAJECTORY PEDICLE SCREWS IN BRAZILIANS

Fernando Magalhães Gosende,Jefferson Soares Leal,Carlos Bauer Namem Lopes Junior,Paula Silveira Santana,Rogério Lúcio Chaves De Resende,Ângelo Ribeiro Vaz De Faria,Luiz Claudio De Moura França

doi:10.1590/s1808-185120201902223974

Fernando Magalhães Gosende, Jefferson Soares Leal + Show 5 more

Open Access

https://doi.org/10.1590/s1808-185120201902223974

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Abstract

ABSTRACT Objective Morphometric study of the positioning of the cortical trajectory pedicle screw in the lumbar spine of Brazilian patients of different sexes and ages, through the use of computed tomography images, in order to obtain more reliable data about cortical screw insertion and the variations observed, providing assistance for a safer, more effective approach with fewer complications. Methods Selection of 100 patients from a database, alternating by sex, measuring the length, diameter, cephalic angulation, and lateral angulation of the vertebrae from L1 to L5. Results Statistically significant measurements were obtained for the four different parameters in relation to sex. The mean age was 56, with a minimum of 20 and a maximum of 87 years. The L4 and L5 screws showed a reduction in relation to the other levels, while the width showed a progressive increase starting at L3. Lateral angulation was the parameter with the least variation among the levels, while there was greater variation and a reduction from L4 to L5 in cephalic angulation. Conclusion Statistically significant results were obtained for length, diameter, lateral and cephalic angulation. Sex was a significant factor in spine surgery instrumentation using the cortical trajectory pedicle screw technique. Level of evidence I; Diagnostic study (investigation of an examination for diagnosis).

Highlights

For several decades, fixation with pedicle screws has been the main technique used for stabilization of the lumbar spine in the treatment of lumbar spinal conditions such as fractures, tumors, and degenerative disease.[1]The insertion of pedicle screws into the lumbar spine is performed through the pedicle, from the lateral to the medial, the point of insertion being located at the junction of the transverse process of the lumbar vertebra with the lateral wall of the upper facet of the vertebra to be fixed.[2]Several potential complications are associated with this technique, such as dislocation of the screw and loss of stability, especially in patients with osteopenia or osteoporosis.[3]
Morphometric study of the positioning of the cortical trajectory pedicle screw in the lumbar spine of Brazilian patients of different sexes and ages, through the use of computed tomography images, in order to obtain more reliable data about cortical screw insertion and the variations observed, providing assistance for a safer, more effective approach with fewer complications
Sex was a significant factor in spine surgery instrumentation using the cortical trajectory pedicle screw technique

Summary

Introduction

Fixation with pedicle screws has been the main technique used for stabilization of the lumbar spine in the treatment of lumbar spinal conditions such as fractures, tumors, and degenerative disease.[1]. Several potential complications are associated with this technique, such as dislocation of the screw and loss of stability, especially in patients with osteopenia or osteoporosis.[3] Another disadvantage includes the significant muscle dissection necessary for the insertion of pedicle screws due to their lateral to medial trajectory[3] and the risk of neural tissue injury.[3,4]. Several advances have been achieved in the development of new screws and new insertion techniques, all seeking to optimize the biomechanical properties and/or minimize the risk of complications.[5] Santoni et al.[6] were the first to describe the cortical trajectory lumbar pedicle screw, known as the “cortical screw.”

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