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Article

Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws

1
Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
2
Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
3
Department of Surgery, School of Medicine, China Medical University, Taichung 40402, Taiwan
4
Department of Neurosurgery, China Medical University Hsinchu Hospital, Hsinchu 30272, Taiwan
5
Department of Neurosurgery, Tainan Municipal An-Nan Hospital-China Medical University, Tainan 70965, Taiwan
6
Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung 40402, Taiwan
7
Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
8
Department of Neurosurgery, Everan Hospital, Taichung 41159, Taiwan
*
Authors to whom correspondence should be addressed.
Academic Editors: William Cho and Makoto Endo
Received: 27 June 2021 / Revised: 10 August 2021 / Accepted: 26 August 2021 / Published: 2 September 2021
(This article belongs to the Special Issue PROTAC—From Bench to Bed)
Purpose: This study aims to elucidate the radiological outcome after Cortical bone trajectory (CBT) screw fixation and whether dual-threaded (DT) screws should be used in the fusion surgery. Methods: 159 patients with degenerative lumbar disorder who had undergone midline lumbar inter-body fusion surgery by CBT screw-fixation technique (2014 to 2018). Patient subgroups were based on single-threaded (ST) or DT screw, fixation length, as well as whether fixation involved to sacrum level (S1). Serial dynamic plain films were reviewed and an appearance of a halo phenomenon between screw–bone interfaces was identified as a case of screw loosening. Results: 29 patients (39.7%) in ST group and 10 patients (11.6%) in DT group demonstrated a halo phenomenon (p < 0.0001 ****). After subgrouping with fixation length, the incidence rates of a halo phenomenon in each group were 11.1%:3% (ST-1L vs. DT-1L), 37%:13.8% (ST-2L vs. DT-2L), and 84.2%:23.5% (ST-3L vs. DT-3L). Among the 85 patients with a fixation involved in S1, 26 patients (52%) with single-threaded screw (STS group) and 8 patients (22.8%) with dual-threaded screw (DTS group) demonstrated a halo appearance (p = 0.0078 **). After subgrouping the fixation level, the incidence of a halo appearance in each group was 25%:0% (STS-1L vs. DTS-1L), 40.9%:26.3% (STS-2L vs. DTS-2L), and 87.5%: 30% (STS-3L vs. DTS-3L). Conclusion: Both fixation length and whether fixation involved to S1 contribute to the incidence of screw loosening, the data supports clinical evidence that DT screws had greater fixation strength with an increased fixative stability and lower incidence of screw loosening in CBT screw fixation compared with ST screws. Level of evidence: 2. View Full-Text
Keywords: cortical bone trajectory; midline lumbar inter-body fusion; screws loosening; screws thread; fixation length cortical bone trajectory; midline lumbar inter-body fusion; screws loosening; screws thread; fixation length
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MDPI and ACS Style

Chen, C.-H.; Tu, C.-H.; Chen, D.-C.; Huang, H.-M.; Chuang, H.-Y.; Cho, D.-Y.; Bau, D.-T.; Lee, H.-C. Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws. Medicines 2021, 8, 50. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8090050

AMA Style

Chen C-H, Tu C-H, Chen D-C, Huang H-M, Chuang H-Y, Cho D-Y, Bau D-T, Lee H-C. Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws. Medicines. 2021; 8(9):50. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8090050

Chicago/Turabian Style

Chen, Chao-Hsuan, Chih-Hsiu Tu, Der-Cherng Chen, Hsiang-Ming Huang, Hao-Yu Chuang, Der-Yang Cho, Da-Tian Bau, and Han-Chung Lee. 2021. "Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws" Medicines 8, no. 9: 50. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8090050

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