Comparative Outcomes of Cortical Bone Trajectory Screw Fixation and Traditional Pedicle Screws in Lumbar Fusion: A Meta-Analysis

Abstract

Pedicular screws (PS) often are used in lumbar fusion. Cortical bone trajectory (CBT) is a novel technology in lumbar fusion with less evidence of clinical outcomes. Therefore, we conducted a meta-analysis to compare the efficacy and safety between CBT screw fixation and traditional PS in lumbar fusion surgery. Multiple databases were searched for the articles that compared CBT and traditional PS in lumbar fusion surgeries. Meta-analysis was conducted by RevMan 5.3 software. The following indicators were abstracted: visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, surgical duration, complications, and blood loss. The quality of the articles was assessed by the Newcastle-Ottawa Scale or Cochrane Handbook. In total, 25 studies were included, involving a total of 1735 patients. There was no difference in preoperative VAS scores, JOA, ODI, postoperative VAS scores, and fusion rates. In addition, postoperative JOA (mean difference [MD]= 0.78, P= 0.02), ODI (MD= -2.09, P=0.03), surgical duration (MD= -26.90, P= 0.02), complications (MD= 0.70, P= 0.03), and blood loss (MD= -85.27, P= 0.0009) showed greater improvement trends in the CBT group than the PS group, with significant difference. CBT reduced the rate of complications, surgical duration, blood loss, postoperative ODI, and JOA scores. The CBT technique, with better postoperative outcomes, achieved similar fusion rates compared with the PS technique.