Comparative Outcomes of Cortical Screw Trajectory Fixation and Pedicle Screw Fixation in Lumbar Spinal Fusion: Systematic Review and Meta-analysis.

Abstract

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). 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. 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. PLIF with CBT screw fixation had postoperative back and leg pain, disabilities, and function score.