Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Table 1 Clinical trials and case reports of the cortical bone trajectory screw fixation

Ref.	Country/region	Study design	Number of cases	Indication	Technique	Revision surgery	Accuracy	Outcomes	Fluoroscopy X-ray dose	Complications	Incision length
Crawford CH 3rd et al[19], 2019	United States	RCCS	56	Spondylolisthesis and foraminal stenosis	Navigated CBT-pedicle screw (29) traditional open TLIF (27)	NA	NA	Lower ODI and less back pain in navigated CBT group	NA	Late reoperations for adjacent segment disease were significantly greater in the traditional open TLIF group	NA
Hsu et al[20], 2020	Taiwan	ROS	12	Thoracolumbar osteoporotic compression fracture	Short-segment CBT instrumentation with vertebroplasty	None	NA	The average blood loss and VAS scores were significantly improved; the average sagittal Cobb angle significantly increased from 15.4° preoperatively to 18.8° postoperatively	NA	None	NA
Noh et al[21], 2021	South Korea	ROS	200	Spinal stenosis, spondylolisthesis, degenerative disc diseases	Open surgery with CBT screw instrumentation	5 cases with adjacent segment disease	NA	Symptom and quality of life significantly improved after surgery	NA	5 cases with ASD, 1 case with screw loosening, 8 cases with dura tear	NA
Takata et al[18], 2014	Japan	ROS	6	Degenerative spondylolisthesis	Hybrid CBT-pedicle screw	NA	NA	Mean operative time 175.8 min. Blood loss 70–200 mL	NA	One had a mild infection after surgery	Around5-6 cm, shorter than that of the conventional PS
Zheng et al[22], 2022	China	RCCS	48	Traumatic thoracolumbar fractures without neurologic defects (type A)	Percutaneous CBT (PCBT 24) OPPS 24	No	NA	VAS scores improved after operation. Blood loss and hospital stay were better in PCBT group	NA	No complications in PCBT group, four cases with complications in OPPS group	PCBT group was better than OPPS group
Petrone et al[23], 2020	Italy	ROS	238	Degenerative lumbosacral disease	First group: 43 cases without CT planningSecond group: 158 cases with CT planning. Third group: 37 cases with 3D printed guide	NA	Screws entirely within the cortex of the pedicle were 78.9%, 90.5% and 93.9% in the three groups	All patients’ symptoms improved after surgery mean operation time was 187, 142 and 124 min in the three subgroups	NA	The total amount of complications were 4.2% (16.3%, 3.8%, 0.0% respectively)	NA
Dayani et al[24], 2019	United States	POS	22	Lumbar degenerative disease and spinal instability	Early experience (first 11 patients) late experience (last 11 patients)	NA	Early experience phase: 66.7% (4/6) of medial pedicle breaches; 100% of lateral vertebral body breach	Late phase: greater efficiency	NA	Incidence of complications decreased in the late phase	NA
Marengo et al[25], 2018	GER	ROS	101	Degenerative lumbo-sacral disease	CT planning	32 patients (31.6%)	NA	Symptom and quality of life improved after surgery; mean procedural time 187 min; mean hospital stay 3.47 days; mean blood loss 383 mL	1.60 mg cm2	4 screws misplaced; 1 wound infection; 1 pseudmeningocele	NA
Chen et al[26], 2018	Taiwan	ROS	6	Lumbar adjacent segment disease	C-arm guidance	Revision surgery:6 cases	NA	Symptom and quality of life improved after surgery	NA	No post-operative complication	NA
Orita et al[27], 2016	Japan	POS	40	Degenerative spondylolisthesis or lateral lumbar disc herniation; stenosis	Percutaneous CBT (pCBT 20); traditional PPS arms (20); C-arm fluoroscope guidance	NA	NA	Clinical outcome regarding LBP and lower limb pain improved with no significant difference between the two groups	Shorter duration of fluoroscopy in PCBT group	No complications	Shorter incision length in PCBT group
Snyder et al[28], 2016	United States	ROS	79	Degenerative lumbosacral disease	Navigation guide	Revision surgery: 20 cases (25.3%)	NA	Mean length of stay was 3.5 days; mean operative blood loss was 306.3 mL	NA	9 complications (8.9%) including hardware failure, pseudarthrosis, DVT, pulmonary embolism, epidural hematoma, wound infection. No complications by misplaced screws	NA
Mai et al[9], 2016	United States	ROS	22	Lumbar spine disease	NA	NA	NA	NA	NA	Screw loosening: 2 intra-operative dural tear: 1. Both a pedicle fracture and screw loosening: 1	NA
Ninomiya et al[29], 2016	Japan	ROS	21	Degenerative spondylolisthesis	Conventional PS (10) CBT (11). C-arm fluoroscope guidance	NA	NA	Symptom and quality of life improved after surgeryboth techniques showed good slip reduction	NA	NA	NA
Elmekaty et al[30], 2018	Sweden	ROS	59	Lumbar spondylolisthesis	MIS-PLF: 22; MIS-TLIF: 15; MIDLF: 22	NA	NA	MIDLF: shorter operation time, less bleeding amount, lower values of CRP and CK than the other two techniques; symptom and quality of life of all the patients improved after surgery	NA	Screw loosening. MIS-PLF: 10%. MIS-TLIF: 7.14%. MIDLF: 4.76%	MIDLF with a small, single posterior midline incision (3.5 cm)
Zhang et al[3], 2021	China	ROS	52	Lumbar tuberculosis	CBT group: 27. PS group: 25	NA	NA	All patients achieved good clinical outcomes; incision pain in CBT group is better than PS group on the 1st day and 3rd day after surgery	NA	All patients have no intraoperative complications	NA
Wochna et al[31], 2018	United States	ROS	71	Traumatic thoracolumbar fractures	ORIF PS: 39; MIS PS: 20; CBT: 12	NA	NA	EBL was 337.50 mL for CBT, 184.33 mL for MIS, and 503.33 mL for ORIF; LOS was 4.06 days fewer for CBT compared to ORIF	NA	1 case of construct failure; 1 case of incisional site infection in the PS group; but none were found in the CBT group	NA
Laratta et al[32], 2019	United States	ROS	134	Degenerative spondylolisthesis mechanical collapse with foraminal stenosisdegenerative scoliosis adjacent segment disease	Navigation with intraoperative CT	Revision surgery: 26.9%	Accuracy rate was 98.3%. The accuracy within 1 mm of error was 99.2%	NA	NA	Lateral breaches: 3 (0.5%); medial breaches: 7 (1.1%)	NA

ROS: Retrospective cohort study; RCCS: Retrospective cohort comparative study; POS: Prospective cohort study; TLIF: Transforaminal lumbar interbody fusion; PS: Pedicle screw; CBT: Cortical bone trajectory; LBP: Lower back pain; PLF: Posterolateral fusion; MIDLF: Midline lumbar fusion; MIS: Minimally invasive spine; EBL: Estimated blood loss; LOS: Length of stay; ORIF: Open reduction internal fixation; OPPS: Open posterior pedicle screw.