Can cortical bone trajectory screws replace traditional trajectory screws in osteoporotic lumbar spine fusion?

Background
Osteoporosis is a challenging condition for spine surgeons. So, improving the instrumentation techniques is mandatory. Cortical trajectory screws, in comparison to pedicle screws, take the most cortical path, which is less affected by osteoporosis, so in this study, we aim to compare the clinical and radiological outcome of cortical bone trajectory screws (CBTS) to traditional trajectory screws (TTS) in osteoporotic patients.


Patients and methods
A randomized clinical trial study was done on 59 osteoporotic patients indicated for lumbar spine fusion: 27 patients in group A were treated using CBTS, and 32 patients in group B were treated with TTS. Patients were followed for at least 1 year clinically and radiologically. Dynamic radiographs and computed tomography to assess fusion and visual analog scale and Oswestry disability index for clinical assessment.


Results
In terms of fusion rate, implant failure, operational time, incisional length, hospital stay, the incidence of complications, and clinical outcome, there was no significant difference between the two study groups (visual analog scale, Oswestry disability index). It was accompanied by decreased intraoperative blood loss than the TTS group (P=0.012) but with greater radiation exposure (P<0.001).


Conclusion
In osteoporotic patients receiving short lumbar fusion surgery, CBTS revealed comparable clinical and radiological outcomes to TTS. So, CBTS could safely replace TTS in short-structure spine fusion surgery in osteoporotic patients.