Comparative Outcomes of Cortical Bone Trajectory Screw Fixation and Traditional Pedicle Screws in Lumbar Fusion: A Meta-Analysis

Qiu, Ling; Niu, Fei; Wu, Zhedong; Zhang, Wei; Chen, Feifei; Tan, Jun; Yan, Jun; Xia, Ping

doi:10.1016/j.wneu.2022.04.129

Cited by 7 publications

(8 citation statements)

References 46 publications

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“…However, there is still no clear consensus regarding the optimal screw trajectory in single vertebrae and functional spine units Phan et al, 2015;Delgado-Fernandez et al, 2017;Hsieh et al, 2021a). Three key Frontiers in Bioengineering and Biotechnology frontiersin.org factors are responsible for the biomechanical performance of pedicle screw fixation: screw mechanical characteristics, bone quality and implantation techniques (Shen et al, 2019;Matsukawa et al, 2021;Qiu et al, 2022). In our study, bone quality, pilot methods and screw morphometric data, including thread type/shape and outer/inner diameter, were controlled; only the lengths of the three methods were different because of the anatomical characteristics Phan et al, 2015;Delgado-Fernandez et al, 2017;Hsieh et al, 2021a).…”

Section: Discussionmentioning

confidence: 92%

Biomechanical comparison of pedicle screw fixation strength among three different screw trajectories using single vertebrae and one-level functional spinal unit

Tai

Chen

Liu

et al. 2022

Front. Bioeng. Biotechnol.

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Three key factors are responsible for the biomechanical performance of pedicle screw fixation: screw mechanical characteristics, bone quality and insertion techniques. To the best of the authors’ knowledge, no study has directly compared the biomechanical performance among three trajectories, i.e., the traditional trajectory (TT), modified trajectory (MT) and cortical bone trajectory (CBT), in a porcine model. This study compared the pullout strength and insertion torque of three trajectory methods in single vertebrae, the pullout strength and fixation stiffness including flexion, extension, and lateral bending in a one-level instrumented functional spinal unit (FSU) that mimics the in vivo configuration were clarified. A total of 18 single vertebrae and 18 FSUs were randomly assigned into three screw insertion methods (n = 6 in each trajectory group). In the TT group, the screw converged from its entry point, passed completely inside the pedicle, was parallel to the superior endplate, was located in the superior third of the vertebral body and reached to at least the anterior third of the vertebral body. In the MT group, the convergent angle was similar to that of the TT method but directed caudally to the anterior inferior margin of the vertebral body. The results of insertion torque and pullout strength in single vertebrae were analyzed; in addition, the stiffness and pullout strength in the one-level FSU were also investigated. This study demonstrated that, in single vertebrae, the insertion torque was significantly higher in CBT groups than in TT and MT groups (p < 0.05). The maximal pullout strength was significantly higher in MT groups than in TT and CBT groups (p < 0.05). There was no significant difference in stiffness in the three motions among all groups. The maximal pullout strength in FSUs of MT and CBT groups were significantly higher than the TT groups (p < 0.05). We concluded that either MT or CBT provides better biomechanical performance than TT in single vertebrae or FSUs. The lack of significance of stiffness in FSUs among three methods suggested that MT or CBT could be a reasonable alternative to TT if the traditional trajectory was not feasible.

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Section: Discussionmentioning

confidence: 92%

Biomechanical comparison of pedicle screw fixation strength among three different screw trajectories using single vertebrae and one-level functional spinal unit

Tai

Chen

Liu

et al. 2022

Front. Bioeng. Biotechnol.

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“…At present, the studies on the clinical efficacy of CBT and PS techniques mainly focus on the comparison of complication rate, fusion rate, revision rate, operation time, blood loss, and other indicators. Keorochana et al [ 43 ] and Qiu et al [ 44 ] demonstrated that the CBT technique had a lower total complication rate than the PS technique. Wang et al [ 8 ] demonstrated that the CBT technique had a lower ASD rate than the PS technique, but there were no significant differences in the hardware complication rate, wound infection rate, fusion rate, and revision rate.…”

Section: Discussionmentioning

confidence: 99%

Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis

et al. 2023

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Background To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. Methods PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. Results The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. Conclusion Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.

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“…This was also emphasised in earlier investigations that utilised a related meta-analysis procedure and originate equivalent values of consequences. [31][32][33][34][35][36][37] Although the meta-analysis was incapable to discover if differences in these characteristics are related to the outcomes being researched, properly-led RCTs are vital to consider these aspects as well as the mixture of different ages, and ethnicities of individuals. In conclusion, no significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF.…”

Section: Discussionmentioning

confidence: 99%

“…Greater, more homogeneous samples are obligatory for this investigation. This was also emphasised in earlier investigations that utilised a related meta‐analysis procedure and originate equivalent values of consequences 31‐37 . Although the meta‐analysis was incapable to discover if differences in these characteristics are related to the outcomes being researched, properly‐led RCTs are vital to consider these aspects as well as the mixture of different ages, and ethnicities of individuals.…”

Section: Discussionmentioning

confidence: 99%

The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta‐analysis

Mao

Wang

2023

International Wound Journal

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A meta‐analysis investigation was performed to measure the influence of cortical bone trajectory screw fixation (CBTSF) and traditional pedicle screw fixation (TPSF) on surgical site wound infection (SSWI) in posterior lumbar fusion (PLF). A comprehensive literature inspection till February 2023 was applied and 1657 interrelated investigations were reviewed. The 13 chosen investigations enclosed 1195 individuals with PLF in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the CBTSF and TPSF on SSWI in PLF by the dichotomous approaches and a fixed or random model. No significant difference was found between individuals using CBTSF and TPSF in SSWI (OR, 0.68; 95% CI, 0.35–1.33, P = .26), superficial SSWI (OR, 0.62; 95% CI, 0.22–1.79, P = .38), and deep SSWI (OR, 0.30; 95% CI, 0.06–1.50, P = .14) in PLF. No significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF. However, care must be exercised when dealing with its values because of the small sample sizes of several chosen investigations for this meta‐analysis and the low number of selected investigations for a certain type of SSWI.

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Comparative Outcomes of Cortical Bone Trajectory Screw Fixation and Traditional Pedicle Screws in Lumbar Fusion: A Meta-Analysis

Cited by 7 publications

References 46 publications

Biomechanical comparison of pedicle screw fixation strength among three different screw trajectories using single vertebrae and one-level functional spinal unit

Biomechanical comparison of pedicle screw fixation strength among three different screw trajectories using single vertebrae and one-level functional spinal unit

Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis

The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta‐analysis

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