• James G Malcolm, Michael K Moore, Falgun H Choksh, Faiz U Ahmad, and Daniel Refai.
• Departments of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
• Neurosurgery. 2018 Dec 1; 83 (6): 1234-1240.

BackgroundThe cortical screw (CS) trajectory for pedicle screw placement is believed to require a smaller incision and less tissue dissection resulting in lower blood loss and faster healing; however, this has not yet been confirmed in clinical studies.ObjectiveTo compare CS transforaminal lumbar interbody fusions (TLIF), traditional pedicle screw (TPS) trajectory TLIFs, and posterolateral fusion (PLF) without interbody for differences in operative characteristics and complications.MethodsWe performed a retrospective cohort study (CS, TPS, and PLF) looking at patients who underwent lumbar fusion with 1 or 2 levels. Extracted data included demographics, comorbidities, estimated blood loss, transfusions, operative time, length of stay, discharge disposition (home vs rehabilitation), and complications within the perioperative, 30- and 90-d periods.ResultsA total of 118 patients (45 CS, 35 TPS, and 38 PLF) were included with average age 62 and 90-d follow-up for 106 (90%) patients. CS had less average blood loss (231 ml) than either TPS (424, P = .0023) or PLF (400, P = .0070). CS had far fewer transfusions than either TPS or PLF (P < .0001). TPS had longer average operating room (OR) time (262 min) than either CS (214, P = .0075) or PLF (211, P = .0060). CS had the shortest length of postoperative stay (4.3 days) which was significantly shorter than PLF (6.2, P = .0138) but not different than TPS (4.8). There were no differences in discharge disposition, complications, perioperative, 30-d, 90-d, durotomy, or wound healing issues.ConclusionThe CS trajectory is associated with less blood loss, fewer transfusions, reduced OR time, and shorter length of stay, with no difference in complications.

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