A meta-analysis of the influences of cortical bone trajectory screw versus traditional pedicle screw fixations on the clinical outcomes in short-segment lumbar fusion

English Keywords:Cortical bone trajectory  Pedicle screw  Lumbar interbody fusion  Clinical outcomes  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the influences on the clinical outcomes of cortical bone trajectory(CBT) screw and pedicle screw(PS) fixations in short-segment lumbar interbody fusion by meta-analysis systematically, so as to provide a theoretical reference for spinal surgeons in selection of appropriate internal fixation methods. Methods: PubMed, Scopus, Web of Science, EI, CNKI and other databases were searched for the relevant literature on the comparison between CBT and PS fixations in lumbar interbody fusion from the inception to July 1, 2022. The intervertebral fusion rate, incidence of surgical complications, incidence of postoperative adjacent segment degeneration(ASD), intraoperative blood loss, operation time, average length of hospital stay, visual analog scale(VAS) of back pain, Oswestry disability index(ODI), and Japanese Orthopaedic Association(JOA) score were extracted, and RevMan 5.3 software was used to perform meta-analysis. The Cochrane risk bias assessment criteria and Newcastle-Ottawa Scale(NOS) risk bias assessment criteria were used to evaluate the quality of enrolled studies respectively for randomized controlled trials and cohort studies. Results: A total of 15 literature were selected, among which 3 were randomized controlled trials and 12 were cohort studies. The evaluation of literature quality suggested that the included literature were of high quality. Meta-analysis showed that CBT group had lower incidence of surgical complications[RR=0.49, 95%CI(0.34, 0.70), P<0.05] and postoperative ASD incidence[RR=0.33, 95%CI(0.16, 0.65), P<0.05]; less intraoperative blood loss[SMD=-0.81, 95% CI(-0.98, -0.63), P<0.05); shorter operative time[SMD=-0.49, 95% CI(-0.67, -0.30), P<0.05) and average length of hospital stay[SMD=-0.60, 95% CI (-0.81, -0.38), P<0.05]; higher JOA score[SMD=0.23, 95% CI (0.02, 0.43), P<0.05]. However, there was no significant difference in interbody fusion rate, back pain VAS score or ODI between the two groups. Conclusions: Comparing with PS fixation, CBT screw fixation was lower in the incidence of surgical complications and postoperative ASD, less in intraoperative blood loss, shorter in operative time and length of hospital stay, and higher in JOA score in short-segment lumbar interbody fusion.