Comparison of Surgical Outcomes between Cortical Bony Trajectory Screw and Traditional Trajectory Screw in Posterior Lumbar Interbody Fusion: A Systematic Review

Abstract

Background: Pedicle screw is the main method for lumbar spine fixation. Pedicle screw fixation allowing correction of spinal Background Data: Pedicle screw is the main method for lumbar spine fixation. Pedicle screw fixation allows correction of spinal deformities and avoids nonunion. Cortical bony trajectory screw (CBTS) is a new procedure in which screw follows an inferior to superior pathway in the sagittal plane and a medial to lateral pathway in the transverse plane. CBTS reduces the operative and postoperative complications and has high fixation strength. Purpose: To compare the clinical and radiological outcomes between CBTS and traditional trajectory screw (TTS) in posterior lumbar interbody fusion. Study Design: Systematic review of literature. Materials and Methods: Comprehensive electronic search in PubMed, Cochrane Library databases, Google Scholar, and ResearchGate for articles that were published between 2009 and 2019 using the following keywords: cortical bony trajectory screw, cortical bony trajectory-pedicle screw, pedicle screw, and posterior lumbar interbody fusion. Results: Eleven articles met our inclusion criteria and were reported. The majority of the published data prove that the CBTS approach has a similar postoperative leg and back pain when compared to TTS although some of them reported less leg and back pain as regards CBTS. Oswestry Disability Index (ODI) and the operative time showed no significant differences between the CBTS and TTS. Radiological outcomes were similar in both procedures regarding fusion rates and vertebral slippage reduction. Blood loss during surgery was significantly less with CBTS compared to TTS. Conclusion: Both Oswestry Disability Index and operative time showed insignificant differences between the CBTS and TTS. Blood loss was significantly less with CBTS compared to TTS. Radiological outcomes were similar in both procedures. CBTS is a reasonable alternative technique to TTS in short segment posterior lumbar interbody fusion although the current literature did not prove its superiority. (2019ESJ197)   deformities and avoid non-union. Cortical Bony Trajectory screw (CBTS) is a new procedure in which screw follow an inferior to superior pathway in the sagittal plane and a medial to lateral pathway in the transverse plane. CBTS is reducing operative and post-operative complications and has high fixation strength. Purpose: To compare the clinical and radiological outcomes between CBTS and traditional trajectory screw (TTS) in surgical management of degenerative spondylolisthesis. Materials and Methods: comprehensive electronic search in PubMed, Cochrane library databases, Google scholar and Research gate for articles that published between 2009 to 2020 using these keywords: Cortical bony trajectory screw, cortical bony trajectory-pedicle screw, Pedicle screw, degenerative lumbar spondylolisthesis. Results: The majority of published data proves that the CBTS approach has a similar postoperative leg and back pain when compared to TTS, although some of them reported less leg and back pain in favor of CBTS. Regarding disability using oswesstry disability index (ODI) and the operative time showed no significant differences between the CBTS and TTS. Radiological outcomes are similar between both studies in bony fusion rates and vertebral reduction. Blood loss during surgery was significantly less with CBTS compared to TTS. Conclusion: Generally, no confirmed agreement regarding comparison of clinical outcomes and drawbacks between the CBTS and TTS approaches. Indications for CBTS and TTS are comparable between most researches, especially in surgical management of degenerative lumbar spondylolisthesis. Keywords: Cortical Bony Trajectory screw - Conventional Screw Trajectory – Degenerative Lumbar Spondylolisthesis