Comparative Analysis Between Cortical Bone Trajectory (CBT) Screw Fixation and Traditional Pedicle Screw Fixation in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

Abstract

Cortical bone trajectory (CBT) screw fixation has been proposed as an alternative method to pedicle screw (PS) fixation for lumbar instrumented fusion. However, the benefits of this technique remain controversial. We searched PubMed, Scopus, Web of Science Advance, ScienceDirect, Embase (Ovid), and Cochrane databases from inception to July 22, 2023. Articles were included if they were related to adults undergoing lumbar spine surgery and showed comparative outcomes with cortical bone and traditional PS trajectory. Twenty-three studies with 1,929 patients (833 in the CBT group and 1,096 in the PS group) were systematically reviewed and meta-analyzed. Significantly lower complications in the CS group, including adjacent segment degeneration (p < 0.05) and screw loosening (p < 0.05), were found. Superior facet joint violation was significantly less in the CBT group (p < 0.05). The CBT group had reduced hospital stay (p < 0.05), reduced blood loss (p < 0.05), and shorter operations (p < 0.05). Clinical outcomes at a mean of 18 months (standard deviation (SD): six months) favored the CBT group in leg pain visual analogue scale (VAS) scores in some subgroups (p < 0.05). Reoperation was significantly reduced in the CBT group (p < 0.05). Our study indicates that CBT fixation has acceptable outcomes relative to PS fixation and may be advantageous in some respects. Further studies are required to ascertain optimal surgical indications for each method.