Open AccessIsthmus‐guided Cortical Bone Trajectory Reduces Postoperative Increases in Serum Creatinine Phosphokinase Concentrations
Author(s) -
Ohkawa Toshika,
Iwatsuki Koichi,
Ohnishi Yuichiro,
Ninomiya Koshi,
Yoshimine Toshiki
Publication year - 2015
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12189
Subject(s) - medicine , surgery , fixation (population genetics) , creatinine , cortical bone , spondylolisthesis , lumbar , decompression , anatomy , population , environmental health
Objective This study aimed to determine whether an isthmus‐guided cortical bone trajectory ( CBT ) technique provides better clinical outcomes than the original cortical bone trajectory CBT technique for screw fixation. Methods A consecutive series of 21 patients with lumbar spondylolisthesis who had undergone CBT screw fixation using the original technique from J une 2012 to F ebruary 2013 and 33 who had undergone the isthmus‐guided technique from M arch 2013 to A ugust 2014 was retrospectively reviewed. The number of screws inserted, interbody fusion and screw misplacements, amount of blood loss, and creatinine phosphokinase ( CPK ) ratios (postoperative day 1 CPK /preoperative CPK ) were reviewed to evaluate clinical outcomes and compared between the original and isthmus‐guided CBT techniques. Results Postoperative serum CPK concentrations were significantly lower with the isthmus‐guided than the original CBT technique ( P < 0.05). There were no significant differences in age, blood loss, or number of screws, vertebral interbody fusions and patients with history of previous decompression surgery at the same level. There was a trend to higher incidence of screw misplacement with the original than the isthmus‐guided CBT technique; this difference was not significant ( P = 0.53). There were no major intraoperative complications. In all the CBT procedures performed in our institution, almost half (47%) the screw misplacements have occurred at the level of L 5 , and most on the right side. Conclusions Right‐handed operators should take care inserting screws on the right side. From the viewpoint of screw misplacement, isthmus‐guided CBT provides superior or equivalent safety to the original CBT technique.