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

PURPOSE: 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). METHOD: 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. RESULTS: 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. CONCLUSIONS: PLIF with CBT screw fixation had postoperative back and leg pain, disabilities, and function score.