Acta Orthopaedica et Traumatologica Turcica
Systematic Review

Can the cortical bone trajectory screw technique be an alternative method to the pedicle screw in posterior lumbar fusion? A systematic review and metaanalysis


Department of Orthopedic Surgery, Gyeongsang National University Hospital, Regional Trauma Center, Jinju, Republic of Korea


Department of Orthopedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea


Clinic of Orthopedic Surgery, Barun Hospital, Jinju, Republic of Korea

AOTT 2021; 55: 552-562
DOI: 10.5152/j.aott.2021.21169
Read: 223 Downloads: 67 Published: 22 December 2021

Objective: The aim of this study was to verify the practicability of the cortical bone trajectory (CBT) method by comparing the clinical outcomes including the complications between the CBT method and pedicle screws (PSs).
Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), web of Science, and SCOPUS electronic databases were searched for relevant articles published through March 2021 that compared the outcomes of the CBT and PSs. The data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The clinical and radiological outcomes of both techniques were evaluated using various outcome measures.
Results: Sixteen studies with a total of 1173 patients were included in the study. The outcomes in the meta-analysis indicated that the use of CBT fixation showed better results for overall complications (P < 0.0001), symptomatic adjacent segment disease (sASD) (P = 0.007), superior facet joint violation (SFJV) rate (P = 0.007), operating time (P = 0.007), intraoperative blood loss (P < 0.00001), incision length (P = 0.002), length of hospital stay (P = 0.0006), and revision rates (P = 0.02). However, there were no statistically significant differences in fusion rates or detailed complications including hardware complications, wound infections (all P > 0.05) between the CBT method and PS fixation groups.
Conclusions: The present study revealed that the CBT method was associated with higher functional recovery, lower surgical morbidity rates, lower revision rates, and lower overall complication rates including sASD and SFJV rates. However, both the CBT method and PSs had similar fusion rates, complications including hardware complications (screw malposition, screw loosening, and screw pullout) and wound infections. Thus, the CBT method did not outperform the PSs in all aspects. Therefore, it is recommended to select a surgical method in consideration of the patient’s bone mineral density, the condition of the pars interarticularis, or the skill level of the surgeon. Prognostic evaluation through long-term follow-up is required, and more high-quality randomized controlled trials are required to verify and strengthen our results.
Level of Evidence: Level III, Therapeutic Study
Cite this article as: Kim K-T, Song M-G, Lee E-C, et al. Can the cortical bone trajectory screw technique be an alternative method to the pedicle screw in posterior lumbar fusion? A systematic review and meta-analysis. Acta Orthop Traumatol Turc 2021; 55(6): 552–562.

ISSN 1017-995X EISSN 2589-1294