Minimally Invasive Lumbar Pedicle Screw Fixation Using Cortical Bone Trajectory: Functional Outcomes

Abstract

Background Pedicle screw fixation is currently the mainstay technique for lumbar spinal fusion; however, more minimally invasive techniques are available such as cortical screw fixation. Numerous studies have proven biomechanical equivalence or superiority for cortical screws but few studies have examined clinical outcomes in patients. Our study aims to examine functional outcomes, as well as fusion rates, in patients who underwent pedicle screw fixation using a cortical trajectory. Methods We retrospectively reviewed prospectively collected functional outcomes data on 10 patients with a degenerative lumbar disease who underwent cortical screw placement by the senior author. Oswestry Disability Index (ODI) and Roland Morris (RM) scoring were calculated preoperatively, at six to 12 weeks and at six to eight months. The Kruskal-Wallis test and Dunn's multiple comparison were used to analyze differences in scores over time. Results We found that over time, cortical screw fixation resulted in a mean decrease of 27 from the baseline ODI at six to eight months (p = 0.014). Additionally, six out of seven (86%) patients who had at least 12 months of radiographic follow-up showed fusion. Conclusions Cortical screw fixation showed a decrease of 27 from the baseline ODI at six to eight months, which is comparable to changes from the baseline ODI reported in three, recent, large clinical trials examining functional outcomes following traditional pedicle screw fixation.