Cortical bone trajectory screws vs pedicle screws in posterior lumbar fusion: a Meta-analysis

English Keywords:Cortical bone trajectory  Cortical screw  Pedicle screw  Lumbar  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To assess the efficacy of cortical bone trajectory(CBT) screw and pedicle screw(PS) technique in posterior lumbar fusion, and to provide evidence for clinical procedure. Methods: Databases including CNKI, CBM, PubMed, The Cochrane Library(Issue 6, 2017), ELSEVIER Science Direct(SDOS) were used to collect randomized controlled trials(RCTs) and cohort study which compared CBT screw fixation with PS fixation in posterior lumbar fusion from inception to June 2017. X-ray, CT and MRI confirmed the diagnosis(including lumbar intervertebral foramen stenosis in lumbar spinal stenosis and severe spondylolisthesis); the ages ranged from 40 to 60 years old. The outcome measures included at least one of the following indicators: the Oswestry disability index(ODI), the Japanese Orthopedic Association(JOA) scale, the visual analogue scale(VAS), the intraoperative blood loss, the operation time, and the fusion outcomes. The quality of the included literature was evaluated by using the Cochrane systematic review manual 5.0.1(an evaluation criteria for randomized controlled trials) and the revised Newcastle Ottawa score(an evaluation criteria for cohort studies), and the Meta-analysis method was used to analyze the related outcome indexes. Results: A total of 1 RCT and 6 cohort studies in English literature were included. 259 cases in group CBT and 289 cases in group PS. Meta-analysis showed that: the amount of bleeding was significantly different between the two groups[MD=-88.83,95%CI(-122.79, -54.88), P<0.01], while no significant differences were found in ODI and JOA scale, VAS, operation time, and fusion outcomes between the two groups(P>0.05). Conclusions: Compared with PS, CBT screw fixation in posterior lumbar fusion can reduce blood loss during operation.