Comparative clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion: a meta‑analysis

doi:10.3969/j.issn.2095-4344.2911

Abstract

Abstract:

BACKGROUND: Currently, pedicle screw fixation is widely used in posterior lumbar interbody fusion. However, due to its shortcomings such as the need of extensive muscle dissection, and invasion of adjacent joints, since 2009, cortical screws were introduced to administrate posterior lumbar interbody fusion in order to reduce intraoperative blood loss and related surgical complications. At present, there are some shortages in the meta-analyses comparing cortical screws with pedicle screws in the use of posterior lumbar interbody fusion, such as including studies with the inconsistent operative methods, or including studies with relatively short follow-up time, or analyses with a rather small sample sizes.

OBJECTIVE: To compare the clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion.

METHODS: The computer was used to search for studies of comparing clinical efficacy of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion in PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang database from January 2009 to January 1, 2020. The data in each research were extracted and sorted into tables. The research data were meta-analyzed and synthesized by RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) A total of 12 articles that met the study criteria, including 2 randomized controlled trials and 10 cohort studies with 929 patients were included in the analysis database. Quality assessment indicated that the included studies had relatively high quality. (2) Meta-analysis results indicated that compared with pedicle screw group, intraoperative blood loss (MD=-68.77, 95%CI: -84.33 to -53.21), operation time (MD=-28.96, 95%CI: -53.11 to -4.82), hospitalization time (MD=-1.59, 95%CI: -2.58 to -0.59) and perioperative complications (OR=-1.95, 95%CI: -4.11-0.20) were statistically significant in the cortical bone trajectory screw group (P < 0.05). Postoperative visual analogue scale back pain score, visual analogue scale leg pain score, Oswestry Dysfunction Index, Japanese orthopaedic association score, long-term complications and fusion rate were not statistically significant. (3) Above data verified that compared with pedicle screw, cortical bone trajectory screw in posterior lumbar interbody fusion can reduce intraoperative blood loss, shorten the operation time and hospitalization time and reduce perioperative complications. However, more prospective, large-scale randomized controlled trials are still needed to provide first-class evidence for verification.

Key words: bone, fracture, screw, fixation, lumbar, bone fusion, meta-analysis

CLC Number:

Chen Haoyan, Xiao Zenglin, Wang Dongping, Xie Weixing, Jin Daxiang. Comparative clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion: a meta‑analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5871-5879.

Figures/Tables 15

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