Comparing Cortical Bone Trajectory and Traditional Pedicle Screws in Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study of One-Year Outcomes

• Authors: Juanmarco Gutierrez Gonzalez, Emory University; Andrew M. Erwood, Emory University; James Malcolm, Emory University; Dayton P. Grogan, Emory University; Alexander C. Greven, Emory University; Matthew F. Gary, Emory University; Gerald Rodts Jr., Emory University; Geoffrey P. Stricsek, Emory University; Daniel Refai, Emory University
• Journal Title: Cureus
• Volume: Volume 15, Number 8
• Publisher: Springer Nature | 2023-08-09, Pages e43237-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7759/cureus.43237
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: posterior spinal instrumented fusion; lumbar spine surgery; posterior spinal fixation and fusion; pedicle screw placement; spine instrumentation

Abstract

Introduction: This is a retrospective study of consecutive patients undergoing transforaminal lumbar interbody fusion (TLIF) at a single institution. The objective of this study was to compare the long-term results associated with cortical bone trajectory (CBT) and traditional pedicle screw (TPS) via posterolateral approach in TLIF. Methods: Consecutive patients treated from November 2014 to March 2019 were included in the CBT TLIF group, while consecutive patients treated from October 2010 to August 2017 were included in the TPS TLIF group. Inclusion criteria comprised single-level or two-level TLIF for degenerative spondylolisthesis with stenosis and at least one year of clinical and radiographic follow-up. Variables of interest included pertinent preoperative, perioperative, and postoperative data. Non-parametric evaluation was performed using the Wilcoxon test. Fisher’s exact test was used to assess group differences for nominal data. Results: Overall, 140 patients met the inclusion criteria; 69 patients had CBT instrumentation (mean follow-up 526 days) and 71 patients underwent instrumentation placement via TPS (mean follow-up 825 days). Examination of perioperative and postoperative outcomes demonstrate comparable results between the groups with perioperative complications, length of stay, discharge destination, surgical revision rate, and fusion rates all being similar between groups (p = 0.1; p = 0.53; p = 0.091; p = 0.61; p = 0.665, respectively). Conclusions: CBT in the setting of TLIF offer equivalent outcomes to TPS with TLIF at both short- and long-term intervals of care.