Application of Cortical Bone Trajectory Screw for Treating Thoracolumbar and Lumbar Tuberculosis

Summary

This protocol describes the treatment of spinal tuberculosis with cortical bone trajectory screws. CBT screw fixation via the posterior and anterior approaches is a promising technique for the treatment of thoracolumbar and lumbar TB.

Abstract

The common form of extrapulmonary tuberculosis is spinal tuberculosis (TB). Spinal TB can lead to vertebral damage, resulting in kyphosis and neurological impairment. Debridement, bone grafting, and reconstruction are common surgical treatments for spinal TB. Spinal TB patients with anterior-middle spinal column destruction are more likely to experience loosening of internal fixation. Cortical bone trajectory (CBT) screw fixation reduces this complication probability because the entrance trajectory of CBT screws in the sagittal and axial planes substantially interacts with the cortical bone and boosts the screw-bone contact strength interface. The CBT screw insertion path is closer to the spinous process and involves less dissection of the paraspinal muscles; this approach appears to reduce intrinsic injury and postoperative pain. CBT screw is a safe and effective internal fixation method for spinal TB because it can effectively reduce the number of fixed segments, maximize spinal mobility, reduce tissue damage, and alleviate postoperative pain at the surgical site.

Introduction

The most frequent form of extrapulmonary tuberculosis is spinal tuberculosis (TB), of which thoracolumbar and lumbar TB are the common types^1,2. Spinal TB can lead to vertebral damage, resulting in kyphosis and neurological impairment³. Although anti-TB chemotherapy is crucial in treating spinal TB, surgical intervention is often necessary to correct kyphosis and recover neurological function. Debridement, bone grafting, and reconstruction are common surgical treatments for spinal TB⁴. Spinal TB is a disease that primarily results in damage to the anterior-middle....

Protocol

The Ethics Committee of Hangzhou Red Cross Hospital approved the study. The patients provided written informed consent for the publication of individual clinical details and accompanying images. Patients with lumbar TB were initially diagnosed according to clinical history, clinical signs, radiographic scan results, and laboratory test results. According to the previous study^13,14, this study uses the laboratory test methods of acid-fast staining and microbiological examination of the focal tissue, and rapid liquid culture to diagnose TB. The inclusion criteria for this study were as follows: lesion limited to....

Results

The mean follow-up time was 61.9 ± 9.1 months. Table 1 shows the mean operation time and intraoperative blood loss. No instances of screw loosening occurred during follow-up. All cases resulted in complete bony fusion at the final follow-up, and the mean bony fusion time was 4.4 ± 0.9 months. The mean Japanese Orthopedic Association (JOA) and visual analog scale (VAS) scores for low back pain and leg pain significantly improved during follow-up versus preoperation (Figure 3).......

Discussion

Among spinal TB cases, surgery combined with anti-TB chemotherapy can always achieve satisfactory outcomes^16,17. Conservative treatment alone cannot alleviate spinal cord pressure, improve neurological dysfunction, or avoid the development of spinal deformities¹⁸. In contrast, surgical intervention can restore spinal stability and alleviate nerve pressure, thereby contributing to disease treatment. Debridement and effective internal fixati.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Cortical bone trajectory screw	Shandong Weigao Orthopaedic Device Co., Ltd.	WGB1Z-7	Used to internal fixation
Kerrison rongeur	Shanghai Medical Instruments Co., Ltd.	P1Z0303	Used for biting dead bone or repairing bone stumps
Periosteal stripping ion	Shanghai Medical Instruments Co., Ltd.	POK01	Used to peel off or separate the periosteum and soft tissue attached to the bone surface
Power System Tools	Aesculap	GA800	Used to open the cortical bone at the CBT screw entry point
spinal rods	Shandong Weigao Orthopaedic Device Co., Ltd.	GB1Z-1	Used to connect screws