title: Clinical Outcomes With Midline Cortical Bone Trajectory Pedicle Screws Versus Traditional Pedicle Screws in Moving Lumbar Fusions From Hospitals to Outpatient Surgery Centers.
abstract: METHODS
  Level III.
  
  
  OBJECTIVE
  To report on the outcomes of midline cortical bone trajectory (CBT) pedicle screw surgical technique for posterior lumbar fixation in the outpatient surgery center (OSC) compared with traditional pedicle screws in the hospital.
  
  
  BACKGROUND
  Traditional pedicle screws have been the gold standard for posterior lumbar fusion. Advances in spine surgery, including less invasive procedures have propelled the design of instruments and implants to achieve greater posterior spinal fixation, with decreased tissue destruction and higher safety margins. Biomechanical studies have validated the superior pullout strength of cortical screws versus the traditional pedicle screws and represent an opportunity to perform safe lumbar fusions in OSCs with same day discharge.
  
  
  METHODS
  The medical records of 60 patients with prospectively collected data were reviewed. Two matched cohort groups consisting of 30 patients each, CBT pedicle screws performed in OSC patients (group 1) was compared with traditional pedicle screws performed in hospital patients (group 2). Outcomes were assessed with self-reported Visual Analog Scale (VAS) scores, Oswestry Disability Index scores, and radiologic fusion rate.
  
  
  RESULTS
  Totally, 33 males and 27 females, age range (28-75), average 58±3 years. Average body mass index was 29±1.15 kg/m. A total of 65% of surgeries were at L5-S1 level. Significant improvement noted in VAS back pain scores in the OSC group from 7.8±0.5 to 2.5±0.7, P=0.001. Comparing intergroup VAS back pain scores and Oswestry Disability Index scores, OSC group demonstrated significant improvement, P=0.004 and 0.027, respectively. Fusion rate at 2 years was similar, P=0.855 between groups.
  
  
  CONCLUSIONS
  We successfully transitioned our lumbar fusions from hospitals to OSCs using a midline CBT pedicle screw technique. Although traditional pedicle screw placement is effective and may be viable in an OSC, we see more advantages to use midline cortical screws over traditional pedicle screws.
authors.affiliation: *Herbert Wertheim College of Medicine at Florida International University †Charles E. Schmidt College of Medicine at Florida Atlantic University, Miami ‡Less Exposure Surgery Specialists Institute (LESS Institute) §Less Exposure Surgery (LES) Society, Fort Lauderdale, FL.
authors.forename: Kingsley R
authors.initials: KR
authors.lastname: Chin
authors.forename: Fabio J R
authors.initials: FJR
authors.lastname: Pencle
authors.forename: André V
authors.initials: AV
authors.lastname: Coombs
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elsharkawy
authors.forename: Corrine F
authors.initials: CF
authors.lastname: Packer
authors.forename: Elijah A
authors.initials: EA
authors.lastname: Hothem
authors.forename: Jason A
authors.initials: JA
authors.lastname: Seale
mesh_terms: D000556:Ambulatory Surgical Procedures; D000071538:Cortical Bone / Q000601:surgery*; D006761:Hospitals; D008159:Lumbar Vertebrae / Q000601:surgery*; D010045:Outpatients; D065289:Pedicle Screws; D013123:Spinal Fusion; D016896:Treatment Outcome