Pedicle screws versus cortical screws in posterior lumbar interbody fusion surgery for degenerative spondylolisthesis: a systematic review and meta-analysis |
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| Authors: | Min Cheol Chang Yoo Jin Choo Gun Woo Lee |
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| Affiliation: | 1. Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, South Korea;2. Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Yeungnam University Hospital, Daegu, South Korea;1. Texas Back Institute, Plano, TX, USA;2. UNT Health Science Center, Fort Worth, TX, USA;3. John Peter Smith Hospital, Fort Worth, TX, USA;1. Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (UBC), Vancouver, Canada;2. Great Ormond Street Hospital, London, United Kingdom;3. Department of Anesthesia, British Columbia Children''s Hospital, Vancouver, Canada;4. Research Institute, BC Children''s Hospital, Vancouver, Canada;1. Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid- Wulumuqi Rd, Shanghai 200040 China;2. Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA;3. Department of Orthopedics, The Fifth People''s Hospital, Fudan University, Shanghai 200240 China;1. Department of Anesthesiology, Brigham and Women''s Hospital, Perioperative and Pain Medicine, Boston, MA, USA;2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 550 N. Broadway, Ste 301, Baltimore, MD 21029, USA;3. Department of Anesthesiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA;4. Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, NY, USA;5. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;6. Persica Pharmaceuticals Ltd, 7 Denne Hill Business Centre, Womenswold, Canterbury, Kent, CT4 6HD, UK |
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| Abstract: | BACKGROUND CONTEXTA few meta-analyses have compared conventional pedicle screws (PS) with cortical bone trajectory-pedicle screws (cortical screw [CS]) in posterior lumbar fusion surgery. However, these studies did not control for diagnosis, which has been shown to impact surgical outcomes.PURPOSETo compare PS with CS as a posterior fixation technique in posterior lumbar interbody fusion (PLIF) for degenerative spondylolisthesis (DS).STUDY DESIGNSystematic review and meta-analysis.METHODSWe searched the Cochrane, Embase, and Medline databases for articles that compared postoperative outcomes between PS and CS for posterior stabilization in PLIF for DS with November 11, 2020, as the publication cutoff. The differences in primary and secondary outcome measures were calculated and analyzed for significance (p<.05). All the reported means were pooled.RESULTSA total of 916 publications were assessed; 5 studies met all the study criteria. The fusion rates between PS and CS groups were not significantly different (p=.41). Blood loss and operative time were significantly less in the CS group than the PS group (p=.04 and 0.02, respectively), but the length of stay was not significantly different (p=.08). The total complication rate was significantly less in CS group than that in PS group (p=.002). The rates of adjacent segment pathology (ASP) and operation for ASP in the CS group were significantly less than the PS group (p=.03 and .04, respectively).CONCLUSIONSThough CS and PS appear to have similar 1-year fusion rates and length of stay, there appears to lower blood loss and operative time with CS. Though encouraging, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias. |
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