Abstract:

Objective

To make a comparative analysis of the efficacy and complications of transforaminal lumbar interbody fusion (TLIF) with cortical bone trajectory (CBT) fixation versus pedicle screw (PS) fixation in the treatment of lumbar degenerative disease combined with osteoporosis.

Methods

Clinical data of patients with single-segment lumbar degenerative disease combined with osteoporosis treated in the Second Affiliated Hospital of the Air Force Medical University from January 2019 to March 2022 were retrospectively analyzed, and the patients were randomly divided into either a CBT fixation group (n=48) or a PS fixation group (n=53) based on the fixation method used. Patients in the CBT group had a mean age of (66.20±8.45) years old, with 37 male and 32 female cases, while those in the PS group had a mean age of (66.83±7.41) years old, with 36 males and 31 females. The mean followup time was (12.20±3.47) months. Visual analogue scale (VAS) score, Oswestry dysfunction index (ODI),operative time, intraoperative bleeding, postoperative drainage, hospitalization days, imaging findings,and complications were compared between the two groups of patients.

Results

Surgery was successfully completed in both groups. Operation time, intraoperative bleeding, incision length, and postoperative drainage were significantly better in the CBT group than in the PS group (P<0.05), but the difference in hospitalization time between the two groups was not statistically significant (P>0.05). Low back pain and leg pain VAS scores and ODI decreased significantly in both groups after surgery (P<0.05). ODI was lower in the CBT group than in the PS group at 3 months postoperatively (P<0.05), though the difference in low back and leg pain VAS scores and ODI at the final follow-up was not statistically significant (P>0.05). The proportion of patients with interbody fusion at the last follow-up was 45/48 (93.75%) in the CBT group and 49/53 (90.57%)in the PS group, and the difference between the two groups was not statistically significant (P>0.05). The screw loosening rate was better in the CBT group than in the PS group (P<0.05).

Conclusion

Improvement of clinical symptoms after single-segment lumbar TLIF fusion with CBT screw fixation in osteoporotic patients is comparable to that with PS fixation, and lumbar stability is significantly better in the CBT group,making CBT fixation a reasonable method in TLIF for osteoporotic patients.

Key words: Cortical bone-trajectory screw, Pedicle screw, Lumbar fusion, Osteoporosis