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

Keorochana, Gun; Pairuchvej, Saran; Trathitephun, Warayos; Arirachakaran, Alisara; Predeeprompan, Pradit; Kongtharvonskul, Jatupon

doi:10.1016/j.wneu.2017.03.010

Cited by 33 publications

(25 citation statements)

References 40 publications

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“…Our meta-analysis showed similar outcomes. For the ODI score, Keorochana et al [35] indicated that there was no difference between the CS and PS groups, but our study indicated that the CS group had a significantly better ODI score than the PS group. Marengo et al [16] also obtained a similar outcome.…”

Section: Discussioncontrasting

confidence: 77%

“…Marengo et al [16] indicated that both CS-PLIF and PS-PLIF improved patient clinical outcome scores (back and leg pain VAS and ODI scores), and CS-PLIF improved more significantly. Keorochana et al [35] indicated that the back and leg pain VAS using the CS fixation technique group was significantly better than the PS group, but there were no significant differences between the CS group and the PS group. Our meta-analysis showed similar outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In lumbar interbody fusion, CS fixation and PS fixation can achieve a good fusion effect, and there is no statistically significant difference between the two groups. For complications, Keorochana et al [35] indicated that the incidence of surgical complications in the CS group was slightly lower than that in the PS group, but this decrease was not statistically significant. However, our meta-analysis yielded different outcomes: the incidence of surgical complications in the CS group was significantly lower than that in the PS group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: a systematic review and meta-analysis

et al. 2019

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Purpose The clinical outcomes of using a cortical screw (CS) for lumbar interbody fusion were evaluated by comparison with conventional pedicle screw (PS) fixation. Methods All of the comparative studies published in the PubMed, Cochrane Library, MEDLINE, Web of Science, and EMBASE databases recently as 18 March 2019, were included. All outcomes were analyzed by using Review Manager 5.3. Results Twelve studies were included with a total of 835 patients, and two of the studies were randomized controlled trials. The outcomes of the meta-analysis indicated that the use of CS fixation for lumbar interbody fusion was better than conventional PS fixation in regard to operating time ( p = 0.02), intraoperative blood loss ( p < 0.00001), length of stay ( p = 0.02), incidence of complications ( p = 0.02), adjacent segmental disease (ASD) incidence ( p = 0.03), and Oswestry Disability Index (ODI) ( p = 0.03). However, there were no statistically significant differences in the back and leg pain visual analog scale (VAS), Japanese Orthopaedic Association (JOA) scale, and intervertebral fusion rate (all p > 0.05) between the CS fixation group and the PS fixation group. Conclusions Based on this systematic review and meta-analysis, our outcomes indicated that both CS and conventional PS can result in good postoperative outcomes in lumbar interbody fusion. No significant differences were found in the back and leg pain VAS, JOA scale, and intervertebral fusion rate. However, CS fixation is superior to PS fixation in the following measures: operating time, intraoperative blood loss, length of stay, incidence of complications, ASD incidence, and ODI. Trial registration PROSPERO registration number is CRD 42019132226 .

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: a systematic review and meta-analysis

et al. 2019

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“…According to a meta‐analysis, CBT is a better option for patients with osteoporosis and obesity. Another meta‐analysis considered that patients who performed CBT had significantly lower postoperative complications than patients treated with PS. Chin et al .…”

Section: Resultsmentioning

confidence: 99%

Comparison of Different Insertion Techniques for Lumbosacral Fixation Improvement: A Finite Element Study

Han

Wang²

2020

Orthopaedic Surgery

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Objective: We create a new S1 cortical screw trajectory technique using 3D reconstruction and the finite element (FE) method to provide a more reliable theoretical basis for clinical practices and to advance internal fixation technology for treatment of lumbosacral degenerative diseases.Methods: This retrospective study included patients (aged from 40 to 70 years) who needed intervertebral fusion surgery between August 2016 and August 2017. Data of patients with lumbosacral lesions was scanned and measured by 64-row spiral CT, and were then transmitted to the GE-AW4.3 post-processing system for 3D reconstruction. The trajectories of the three different screws were simulated by FE software and processed by mimics software to simulate the screw path: traditional PS fixation (Model A); traditional cortical screw (Model B); and new cortical screw (Model C). The CT value of the bone around the screw canal was recorded. Biomechanical effects of the three screws were analyzed and compared.Results: The displacement of flexion and extension, the vertebral body stress of right torsion, and the cage stress of flexion showed no significant differences among the three models (P > 0.05). The results demonstrated that cortical screws exceeded pedicle screws in stability and pullout force. Models B and C showed higher vertebral displacement in left bending (0.41 and 0.31 mm) and right bending (0.58 and 0.40 mm), lower vertebral body stress on extension (48.37 and 38.92 MPa), left bending (0.76 and 0.74 mm) and right bending (0.50 and 0.53 mm), and higher cage stress on left bending (162.19 and 160.63 MPa), right bending (150.02 and 150.05 MPa), left torsion (158.45 and 146.27 MPa) and right torsion (167.33 and 171.15 MPa) (all P < 0.05) compared to model A. Compared to Model B, Model C had higher displacement of left and right torsion, lower pressure in extension and flexion, and lower stress on cages in extension (P < 0.05). Conclusion:The new cortical screw insertion method has similar effects to traditional cortical screw fixation. However, it demonstrated advantages in promoting lumbosacral interbody fusion, which protects vessels and nerves.

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“…Here, we report a case of FDI showing a fracture line through the transverse process and pedicle on one side, and into the vertebral body, combined with disruptions of the posterior ligamentous complex, in which single-level fusion was successfully achieved with the utilization of a cortical bone trajectory (CBT) pedicle screw. The CBT screw technique, with trajectory from medial to lateral and caudal to cranial, was developed by Santoni et al [ 9 ] in 2009 as an alternative strategy to obtain improved pedicle screw fixation in the lumbar spine, and is now commonly used in combination with interbody fusion for the treatment of degenerative lumbar spine diseases [ 10 , 11 ]. To the best of our knowledge, utilizing a CBT pedicle screw as an osteosynthesis screw in FDIs has not previously been described.…”

Section: Introductionmentioning

confidence: 99%

Utilizing a Cortical Bone Trajectory Pedicle Screw for Lumbar Flexion-Distraction Injury

Miyakoshi

Maekawa²,

Urayama³

et al. 2018

Case Reports in Orthopedics

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Spinal flexion-distraction injuries (FDIs) are unstable fractures, commonly located at the thoracolumbar junction. Management of FDIs often necessitates the use of posterior instrumentation and fusion, but long-segment instrumentation surgery decreases postoperative spinal mobility and increases the risk of junctional kyphosis and fracture. We report the case of a patient with FDI showing an L2 vertebral fracture, unilateral L2 pedicle fracture, and disruptions of the posterior ligamentous complex between L1 and L2. After open reduction using L1 and L2 pedicle screws with a conventional trajectory on the right side, a cortical bone trajectory (CBT) pedicle screw was used as an osteosynthesis screw for the fractured left pedicle. This procedure enabled successful single-level fusion. Follow-up radiological examination revealed good reduction and complete bone union. To the best of our knowledge, utilizing a CBT technique as an osteosynthesis screw in FDIs has not previously been described.

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

Cited by 33 publications

References 40 publications

Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: a systematic review and meta-analysis

Comparison of outcomes between cortical screws and traditional pedicle screws for lumbar interbody fusion: a systematic review and meta-analysis

Comparison of Different Insertion Techniques for Lumbosacral Fixation Improvement: A Finite Element Study

Utilizing a Cortical Bone Trajectory Pedicle Screw for Lumbar Flexion-Distraction Injury

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