Cortical Bone Trajectory Screw Versus Pedicle Screw Fixation After Posterior Lumbar Interbody Fusion:A Meta-Analysis

BackgroundTraditional pedicle screw fixation technique has been widely used in posterior lumbar interbody fusion.Because of its complications such as extensive soft tissue dissection and invasion of intervertebral joints,since 2009,cortical bone trajectory screw fixation technique has been gradually used in posterior lumbar interbody fusion surgery in order to reduce these complications.There is a lack of meta-analysis exploring the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusionObjectiveTo evaluate the clinical efficacy of cortical bone trajectory screw fixation versus traditional pedicle screw fixation after posterior lumbar interbody fusion by meta-analysis.MethodsA computer-based search in databases of PubMed,The Cochrane Library,Embase,Scopus,Web of Science,CNKI,CBM,and WanFang was conducted for the articles published before July 2018.“CBT,cortical bone trajectory,cortical screw,PS,pedicle screw” were used as keywords in English and Chinese,respectively.Two researchers independently screened the retrieved literature,evaluated the quality of the included literature and extracted the data.Meta-analysis was performed using Rev Man 5.2 software.ResultsA total of 8 literatures were included,including 7 in English and 1 in Chinese,2 in randomized controlled trials,and 6 in cohort studies.656 cases were included,319 in cortical trajectory screw group and 337 in pedicle screw group.The results of meta-analysis showed that there were significant differences in operation time,intraoperative blood loss and hospitalization time between two groups,and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).There were significant differences in the perioperative complications,total complications during follow-up and secondary operation rate between two groups,and the cortical trajectory screw group was superior to the pedicle screw group(P < 0.05).The long-term complications and intervertebral fusion rate did not differ significantly between two groups(P > 0.05).ConclusionThese results indicate that the cortical bone trajectory screws are better than the traditional pedicle screws in the operation time,intraoperative blood loss,hospitalization time,perioperative complications,total complications and secondary operation rate.But there is no significant difference in the intervertebral fusion rate and long-term complications between two methods.