Secure spinal fixation using an innovative dual-trajectory technique in patients with osteoporosis: Surgical technique and case series

Fu-Cheng Kao ； Tsung-Ting Tsai ； Yu-Wen Tseng ； Chao-Yaug Liao

《Formosan Journal of Musculoskeletal Disorders》 11卷3期 (2020/08) Pp. 116-122

https://doi.org/10.6492/FJMD.202008_11(3).0004

摘要

In the present study, we propose a new spinal fixation technique, named the dual-trajectory technique, which applies cortical bone and pedicle cross-trajectory fixation in a single pedicle. We discuss its clinical use, advantages, and complications in 6 patients and provide a review of the literature. Six patients (4 women and 2 men) who underwent the dual-trajectory technique at our hospital between June 2016 and January 2017 were enrolled in this study. Four patients had infectious spondylodiscitis with end-stage renal disease, one had postoperative pedicle screw loosening with spondylolisthesis, and 1 had multilevel traumatic spine fracture and single-level Chance fracture. Mean age was 64.7 ± 8.9 years (range, 51-75 years) and mean bone mineral density T-score was -3.7 ± 0.6. All patients felt significant symptomatic relief postoperatively, expect for 1 patient who experienced severe right inguinal pain and numbness due to upper nerve root injury caused by screw malpositioning. The dual-trajectory technique provided secure spinal fixation, especially in patients with severe osteoporosis. This technique can shorten fixation, reduce soft tissue dissection, and decrease risk of neurologic damage. However, this procedure is technically demanding and requires greater radiation exposure than traditional trajectory techniques.

關鍵字

cortical bone trajectory ； osteoporosis ； pedicle screw ； spinal fixation