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Cited 2 time in webofscience Cited 4 time in scopus
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Can the cortical bone trajectory screw technique be an alternative method to the pedicle screw in posterior lumbar fusion? A systematic review and meta-analysisopen access

Authors
Kim, Kun-TaeSong, Myung-GeunLee, Eun-ChangSeo, Min-SeokLee, Dong-YeongKim, DongHee
Issue Date
Nov-2021
Publisher
TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY
Keywords
Cortical bone trajectory; Pedicle screw; Posterior lumbar fusion; Meta-analysis; Systematic review
Citation
ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA, v.55, no.6, pp.552 - 562
Indexed
SCIE
SCOPUS
Journal Title
ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA
Volume
55
Number
6
Start Page
552
End Page
562
URI
https://scholarworks.bwise.kr/gnu/handle/sw.gnu/3030
DOI
10.5152/j.aott.2021.21169
ISSN
1017-995X
Abstract
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.
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