Comparative Outcomes of Cortical Screw Trajectory Fixation and Pedicle Screw Fixation in Lumbar Spinal Fusion: Systematic Review and Meta-analysis.
OBJECTIVE
We conducted a systematic review and meta-analysis to compare the postoperative outcomes of cortical screw and pedicle screw (PS) fixation techniques for posterior lumbar interbody fusion (PLIF).


METHODS
We searched all comparative studies that compared postoperative outcomes of cortical screw and PS fixation techniques for lumbar spinal fusions from the PubMed and Scopus databases up to 2 October 2016.


RESULTS
Eight of 1147 studies (N = 466 patients) were eligible: 5 back pain Visual Analog Scale (VAS); 4 leg pain VAS; 3 Oswestry Disability Index; 2 Japanese Orthopaedic Association scale; 5 intraoperative complications (dural tear and misplacement); 6 postoperative complications (hematoma, infection, adjacent segment disease and fracture); and 4 fusion rate studies were included. The unstandardized mean difference of back and leg pain VAS and Oswestry Disability Index of cortical bone trajectory (CBT) screw fixation was -0.14 (95% confidence interval [CI]: -2.46, 2.19), -0.46 (95% CI: -1.21, 0.29), and -1.64 (95% CI: -4.17, 0.89) scores lower than PS fixation for PLIF, but without statistical significance. Whereas PLIF with CBT screw fixation was insignificant higher Japanese Orthopaedic Association score of 0.87 (95% CI: -0.06, 1.81) when compared with PS fixation. CBT had a statistically significantly lower chance of postoperative complications by 0.49 (95% CI: 0.25, 0.95) when compared with PS fixation technique. However, CBT had no insignificant lower chance of intraoperative complication by 0.82 (95% CI: 0.28, 2.41) when compared with the PS technique.


CONCLUSIONS
PLIF with CBT screw fixation had postoperative back and leg pain, disabilities, and function score.
Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Gun
G
Keorochana
Orthopedics Department, Queen Savang Vadhana Memorial Hospital, Sriracha, Cholburi, Thailand.
Saran
S
Pairuchvej
Orthopedics Department, Chulabhorn Hospital, Bangkok, Thailand.
Warayos
W
Trathitephun
Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Alisara
A
Arirachakaran
Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Pradit
P
Predeeprompan
Sports and Orthopedics Center, Samitivej hospital, Bangkok, Thailand. Electronic address: Jatupon_kong@hotmail.com.
Jatupon
J
Kongtharvonskul
D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D009983:Orthopedic Equipment; D009985:Orthopedics / Q000379:methods*; D065289:Pedicle Screws; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D016896:Treatment Outcome
Cortical bone trajectory; Lumbar fusion; Pedicle screw