Midline lumbar fusion using cortical bone trajectory screws. Preliminary report.
BACKGROUND
Midline lumbar fusion (MIDLF) using cortical bone trajectory is an alternative method of transpedicular spinal fusion for degenerative disease. The new entry points' location and screwdriving direction allow the approach-related morbidity to be reduced.


OBJECTIVE
To present our preliminary experience with the MIDLF technique on the first 5 patients with lumbar degenerative disease and with follow-up of at least 6 months.


METHODS
Retrospective analysis was performed on the first 5 patients with foraminal (4) or central (1) stenosis operated on between December 2014 and February 2015. Three patients were fused at L4-L5 and two at the L5-S1 level.


RESULTS
No intra- or post-operative complications occurred with this approach. An improvement regarding the leading symptom in the early postoperative period (sciatica 4/4, claudication 1/1) was achieved in all patients. The mean improvements in the visual analogue scale for low back and leg pain were 2.2 and 4.8 respectively. The mean Oswestry Disability Index scores were 52% (range: 16-82%) before surgery and 33% (range: 12-56%) at 3-month follow-up (mean improvement 19%). At the most recent follow-up, 4 patients reported the maintenance of the satisfactory result. The early standing and follow-up X-rays showed satisfactory screw placement in all patients.


CONCLUSIONS
In our initial experience, the MIDLF technique seems to be an encouraging alternative to traditional transpedicular trajectory screws when short level lumbar fusion is needed. Nevertheless, longer observations on larger groups of patients are needed to reliably evaluate the safety of the method and the sustainability of the results.
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Mateusz
M
Bielecki
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Przemysław
P
Kunert
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Marek
M
Prokopienko
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Arkadiusz
A
Nowak
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Tomasz
T
Czernicki
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Andrzej
A
Marchel
cortical bone trajectory; lumbar degenerative disease; midline lumbar fusion; minimally invasive spine surgery; pedicle screw