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Comparative clinical efficacy and safety of cortical bone trajectory screw fixation and traditional pedicle screw fixation in posterior lumbar fusion: a systematic review and meta-analysis

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Abstract

Purpose

To compare the clinical efficacy and safety between cortical bone trajectory (CBT) and pedicle screw (PS) in posterior lumbar fusion surgery.

Methods

Five electronic databases were used to identify relevant studies comparing the clinical efficacy and safety between CBT and PS. The main outcomes were postoperative fusion rates and complication (especially in superior facet joint violations, symptomatic ASD, wound infection, dural tear, screw malposition and hematoma). The secondary results included operation time, intraoperative blood loss, length of hospital stay, incision length, ODI, VAS, JOA score, JOA recovery rate, patients’ satisfaction and health-related quality of life.

Results

The outcomes showed that there was no significant difference in terms of fusion rate (p = 0.55), back and leg VAS score (p > 0.05), JOA score (p = 0.08) and incidence of reoperation (p = 0.07). However, CBT was superior to PS with Oswestry Disability Index (ODI) (p = 0.02), JOA recovery rate (p < 0.00001) and patients’ satisfaction (p = 0.001). In addition, CBT was superior to PS with significantly lower incidence of superior facet joint violation and symptomatic ASD. However, there was no significant difference regarding wound infection (p > 0.05) and screw malposition (p > 0.05). CBT group required significant shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay in comparison with PS group (p < 0.05).

Conclusions

Both CBT and PS achieve similar, fusion rate and revision surgery rate. Furthermore, CBT is superior to PS with lower incidence of complications, shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay.

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Acknowledgements

We would like to thank all the people who give the help for this study.

Funding

This work was supported by grants from Tianjin Natural Science Foundation of China (18JCYBJC28200).

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Authors and Affiliations

  1. Tianjin Medical University, Tianjin, 300070, People’s Republic of China

    Jizhou Wang & Xiaoqi He

  2. Department of Spinal Surgery, Tianjin Union Medical Center, 190 Jieyuan Rd, Hongqiao District, Tianjin, 300121, People’s Republic of China

    Jizhou Wang, Xiaoqi He & Tianwei Sun

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  1. Jizhou Wang
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Correspondence to Tianwei Sun.

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Wang, J., He, X. & Sun, T. Comparative clinical efficacy and safety of cortical bone trajectory screw fixation and traditional pedicle screw fixation in posterior lumbar fusion: a systematic review and meta-analysis. Eur Spine J 28, 1678–1689 (2019). https://doi.org/10.1007/s00586-019-05999-y

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