Research Fellow University of North Carolina at Chapel Hill Chapel Hill, NC, US
Introduction: Transforaminal lumbar interbody fusion (TLIF) is a well-established surgical technique for treating degenerative lumbar spine conditions. Traditionally, TLIF has been performed using pedicle screw fixation (PS) to achieve spinal stability. However, the cortical bone trajectory (CBT) technique has emerged as a potential alternative, offering advantages such as reduced muscle dissection and lower risk of nerve injury. We aim to compare CBT versus PS to assess surgical outcomes, including fusion rate, complications, operative time, and estimated blood loss (EBL).
Methods: PubMed, EMBASE, and CENTRAL were systematically searched until September 2024. Statistical analysis was conducted using R version 4.4.0 with the packages ‘meta’ and ‘metafor’. Random-effects meta-analysis was estimated using the Mantel–Haenszel method with relative risk (RR) for dichotomous outcomes and the DerSimonian–Laird estimator with mean difference (MD) for continuous outcomes.
Results: A total of 7 studies comprising 692 patients were included. The mean age was 66 years, and 367 (53.04%) were women. Our findings indicate a significant reduction in EBL with CBT, with an MD of −49.16 mL (95% CI = −90.66 to −7.66, p=0.03, Fig. 1A). Although there was a trend towards decreased operative time with CBT (MD: −14.72 minutes, 95% CI = −30.88 to 1.44, p=0.07, Fig. 1B), did not reach statistical significance. The complications (RR: 0.82, 95% CI = 0.42 to 1.62, p=0.49, Fig. 1C) and fusion rates (RR: 1.02, 95% CI = 0.91 to 1.14, p=0.70, Fig. D) were not statistically significant.
Conclusion : Our meta-analysis suggests that CBT can be considered a viable alternative to PS in TLIF for reducing EBL. This could lead to broader adoption of CBT in clinical practice, although clinicians should also consider the technique-specific training and patient selection criteria that may affect the outcomes.
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