Oliver P Gautschi1, Diego Garbossa2, Enrico Tessitore1, Francesco Langella3, Michele F Pecoraro2, Nicola Marengo4, Marco Bozzaro2, Joshua Beckman5, Pedro Berjano6. 1. Service of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland. 2. Division of Neurosurgery, Department of Neurosciences and Mental Health, University of Turin, Turin, Italy. 3. Division of Orthopedics, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy. 4. Division of Neurosurgery, Department of Neurosciences and Mental Health, University of Turin, Turin, Italy - nicola.marengo@gmail.com. 5. Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA. 6. IV Spine Surgery Division, Galeazzi Orthopedic Institute for Scientific Research, Milan, Italy.
Abstract
BACKGROUND: First advocated by Santoni et al. in 2009, the cortical bone trajectory pedicle screw technique is an alternative to the traditional, convergent technique that shows comparable biomechanical features and potentially requires less aggressive tissue retraction. Aim of this therapy note is to describe this new technique focusing on main advantages and limitations. METHODS: The authors provide a detailed description of the surgically relevant anatomy focusing on the positioning of the cortical trajectory screws. The surgical technique is then described in a precise step-by-step manner, stressing complication avoidance. RESULTS: The maximal access surgery posterior lumbar interbody fusion approach is a safe, reproducible procedure allowing for a traditional lumbar spine approach with the benefits of minimal facet joint manipulation and potentially preserving part of their neural innervation and a large part of the paraspinous musculature. CONCLUSIONS: A dedicated self-retaining retractor and directional neuromonitoring may guide surgeons during the procedure. Nevertheless, the surgeon's knowledge of anatomical landmarks, response to visual and tactile cues and intraoperative decision-making skills remain of paramount importance.
BACKGROUND: First advocated by Santoni et al. in 2009, the cortical bone trajectory pedicle screw technique is an alternative to the traditional, convergent technique that shows comparable biomechanical features and potentially requires less aggressive tissue retraction. Aim of this therapy note is to describe this new technique focusing on main advantages and limitations. METHODS: The authors provide a detailed description of the surgically relevant anatomy focusing on the positioning of the cortical trajectory screws. The surgical technique is then described in a precise step-by-step manner, stressing complication avoidance. RESULTS: The maximal access surgery posterior lumbar interbody fusion approach is a safe, reproducible procedure allowing for a traditional lumbar spine approach with the benefits of minimal facet joint manipulation and potentially preserving part of their neural innervation and a large part of the paraspinous musculature. CONCLUSIONS: A dedicated self-retaining retractor and directional neuromonitoring may guide surgeons during the procedure. Nevertheless, the surgeon's knowledge of anatomical landmarks, response to visual and tactile cues and intraoperative decision-making skills remain of paramount importance.
Authors: Pedro Berjano; Juan Francisco Blanco; Diego Rendon; Jorge Hugo Villafañe; David Pescador; Carlos Manuel Atienza Journal: Eur Spine J Date: 2015-10-09 Impact factor: 3.134