There have been a number of developments in screw design and implantation techniques over recent years, including proposal of an alternative trajectory for screw fixation aimed at increasing purchase of pedicle screws in higher density bone. Cortical bone trajectory (CBT) screw insertion follows a lateral path in the transverse plane and caudocephalad path in the sagittal plane. This technique has been advocated because it is reportedly less invasive, improves screw−bone purchase and reduces neurovascular injury; however, these claims have not been supported by robust clinical evidence. The available evidence was therefore reviewed to assess the relative merits of CBT and highlight areas for further research. To this end, a search of relevant published studies reporting biomechanical, morphometric or clinical outcomes after use of CBT screws in patients with spinal pathologies was performed via six electronic databases.
From the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.
Our review demonstrates a lack of standardisation within SIU on a global scale, with significantly different outcomes reported across published studies. New and higher quality evidence directly comparing SIU to non-SIU based care is required. Earlier transfer (<24 h) to SIU following initial injury and stabilisation is advised.
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