| BACKGROUND: Transforaminal lumbar interbody fusion(TLIF)is a common lumbar fusion surgery which is widely used in the treatment of lumbar degenerative disc disorders.Lumbar fixation in Transforaminal lumbar interbody fusion surgery using the traditional pedicle screw(PS)provides several advantages but at the same time also has some drawbacks such as risk of violation of facet joint and muscle damage.Recently the new trajectory for insertion of pedicle screw called cortical bone trajectory(CBT)has been invented which can be inserted without these drawbacks associated with the traditional pedicle screw.However,the clinical efficacy of TLIF with CBT compared to TLIF with PS has not been fully evaluated.OBJECTIVE: The purpose of this study is to compare the clinical effectiveness of cortical bone trajectory(CBT)and traditional pedicle screw(PS)techniques in transforaminal lumbar interbody fusion(TLIF)surgery.STUDY DESIGN: This is Retrospective observational study.METHOD AND MATERIALS: A total of 71 eligible patients who went single level TLIF surgery at Spine Center of Zhongda Hospital Southeast university were collected and assigned to group A(45 patients)in which PS was used and group B(26 patients)in which CBT screw was used.Fusion status was evaluated at 1 year using the plain radiograph and computed tomography(CT)scan.Clinical outcomes were assessed by using VAS score for back and leg pain,oswetry disability index(ODI)score and Japanese Orthopedic Association(JOA)score.The operative time,blood loss,incision length and the postoperative hospital stay were also recorded and compared between the two groups.The follow up for the patients in both groups were done for 1 year after the surgery.Different statistical methods were used for the analysis of data and p value <0.05 was considered statistically significant.RESULTS: At one year follow up,fusion rate was similar between the PS and CBT groups(40 of 45 patients in PS group,23 of 26 patients in CBT group;p>0.05).According to the clinical outcomes,VAS score for low back pain and leg pain,ODI score and JOA score showed no significant difference between the two groups at final follow up(p=0.74,p=0.46,p=0.63 and p=0.56 respectively).The mean operative time was significantly shorter in CBT group when compared to PS group(p=0.02).The average blood loss was lower in CBT group(p<0.05).The incision length and postoperative hospital stay were also shorter in the CBT group(p<0.05).No serious perioperative and radiological complication were seen in both groups.CONCLUSION: TLIF with CBT has similar clinical outcomes and fusion rates compared to PS,but TLIF with CBT provides additional benefit of shorter operative time,less blood loss,shorter incision length and shorter postoperative hospital stay.Thus,CBT can be considered as a reasonable alternative to PS in TLIF. |
