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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2021.tde-09092021-080409
Document
Author
Full name
Rafael Campos Fróes Marangoni
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Herrero, Carlos Fernando Pereira da Silva (President)
Mandarano Filho, Luiz Garcia
Porto, Maximiliano Aguiar
Title in Portuguese
Análise tomográfica dos parâmetros anatômicos para inserção dos parafusos de trajeto cortical
Keywords in Portuguese
Cirurgia minimamente invasiva
Coluna vertebral
Lombar
Parafuso cortical
Abstract in Portuguese
Em 2009, Santoni e cols. introduziram um novo método de inserção de parafusos pediculares que ficou conhecida como parafuso de trajeto cortical (PTC). Nesta técnica a inserção do parafuso segue o trajeto de distal para proximal no plano sagital e a direção lateral no plano transverso, o que aumenta o contato com o osso cortical no pedículo e no corpo vertebral. O objetivo do estudo foi estudar os parâmetros anatômicos do trajeto de inserção do parafuso cortical e descrever sua técnica. Analisou-se exames de tomografia computadorizada de 30 pacientes, medidas nas vértebras de L1 a L5 bilateralmente. Um segundo observador avaliou 10 exames aleatoriamente. Os parâmetros incluíram ângulo lateral (AL), diâmetro do parafuso (DMP), ângulo cranial (AC) e o comprimento do parafuso (CP). 15 pacientes do sexo masculino (média de idade de 31,33 anos) e 15 do sexo feminino (média de idade de 32,01). O AL variou de 13,8º a 20,89º, com uma tendência de aumento no sentido de proximal para distal. O AC variou de 17,5º a 24,9º, com tendência de diminuição no sentido caudal. O DMP variou de 2,3 mm a 7,2 mm, havendo uma tendência ao aumento conforme avançamos de proximal para distal. O CP variou de 19 mm a 45 mm, havendo uma tendência de diminuição conforme avançamos de proximal (L1) para distal (L5). Não houve diferença estatística nos valores estudados quando comparados os lados, entre os sexos nem diferenças interobservador. A trajetória do parafuso de trajeto cortical apresenta variação entre diferentes populações. Assim, recomendamos o estudo pré-operatório de imagens para reduzir os riscos cirúrgicos relacionados à técnica.
Title in English
Tomographic analysis of anatomical parameters for insertion of cortical bone screws
Keywords in English
Cortical bone screw lumbar
Minimally invasive surgery
Spine
Abstract in English
In 2009, Santoni et al. introduced a new method for inserting pedicle screws that became known as the cortical bone screw (CBS). In this technique, the screw insertion follows the path from distal to proximal in the sagittal plane and the lateral direction in the transverse plane, which increases the contact with the cortical bone in the pedicle and in the vertebral body. The objetive is to study the anatomical parameters related to the insertion path of the cortical screw. The CT scans of 30 patients were evaluated. Measurements from L1 to L5 vertebrae were studied bilaterally. A second observer evaluated 10 randomly selected exams. The parameters studied included lateral angle (AL) and screw diameter (DMP) as axial variables, and cranial angle (AC) and screw length (CP) as sagittal variables. We studied 15 male patients (mean age 31.33 years) and 15 female patients (mean age was 32.01). AL varied between 13.8º and 20.89º, with a tendency to increase in the proximal to distal direction. The AC varied from 17.5º to 24.9º, with a tendency to decrease in the caudal direction. The DMP ranged from 2,3mm to 7,2mm, with a tendency to increase as we progressed from proximal to distal. The CP varied from 19 to 45 mm, with a tendency to decrease in CP measurements as we proceeded from proximal (L1) to distal (L5). No statistical difference was observed in the values studied when comparing the sides, between the genders or inter-observer correlation. The cortical screw has shown a variation between different populations. Alongside, we recommend a suitable preoperative image study to reduce the surgical risks related to the technique.
 
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Publishing Date
2021-10-04
 
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