Cortical Trajectory versus Traditional Pedicle Screw Trajectory in Open Transforaminal Lumbar Interbody Fusion: Meta-Analysis of Complications and Clinical Outcomes

BACKGROUND: Lumbar degenerative disease imposes a substantial burden on global health care expenditures. Transforaminal lumbar interbody fusion (TLIF) using either traditional trajectory (TT) pedicle screws or cortical bone trajectory (CBT) pedicle screws has become increasingly common. This meta- analysis evaluated outcomes and safety of open TLIF with TT compared with CBT. METHODS: PubMed, Cochrane, and Google Scholar were searched up to April 2024. The studied outcomes included complications, revision surgeries, operating room time, estimated blood loss, length of hospital stay (LOS), incision length, Visual Analog Scale, Oswestry Disability Index, and Japanese Orthopedic Association. RESULTS: This meta-analysis included 5 studies; 770 patients undergoing TLIF were included, with 415 in the CBT group and 355 in the TT group. No statistically significant differences were found in the rate of overall complications, including specific complications, rate of revision surgeries, patient-reported outcome measures, operating room time, and estimated blood loss. However, the CBT group demonstrated shorter LOS (P P [ 0.05) and shorter incision lengths (P< P < 0.001) compared with the TT group. CONCLUSIONS: TT and CBT in TLIF procedures demonstrated comparable rates of complications, reoperations, and patient-reported outcome measures. Despite similar operating room times and estimated blood loss, the CBT group exhibited shorter incision lengths and shorter LOS than the TT group. Both CBT and TT pedicle screws are safe and effective options for TLIF. There are potential benefits to CBT such as shorter incision and LOS, although TT remains an essential tool for spinal instrumentation techniques.