Comparison of Cortical Bone Trajectory and Percutaneous Pedicle Screw Fixation in PETLIF: Short-Term Perioperative Muscle Injury and Pain Outcomes
In brief
Cortical screws had 28% lower day-one CK levels in PETLIF
In this retrospective study of 140 patients, those treated with cortical bone trajectory screws had lower day-one creatine kinase levels and less low back pain on day 7 than patients with percutaneous pedicle screws. Other measured functional and imaging outcomes were similar, but surgeon choice and more frequent direct decompression in the cortical screw group complicate the comparison; long-term outcomes remain unknown.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 15 September 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Daisuke Ukeba, Ken Nagahama, Yoshinori Hyugaji, Katsuhisa Yamada, Hideki Sudo, Tsutomu Endo, et al.
- PMID
- 42795947
- DOI
- 10.3390/jcm15187174
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 1 October 2026): PETLIF CBT vs PPS fixation outcomes
Abstract
Background/Objectives: Full-endoscopic transforaminal approach lumbar interbody fusion using the percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) system is increasingly adopted as a minimally invasive technique for degenerative lumbar disorders. Screw trajectory selection may influence tissue handling, muscle injury, and postoperative pain. Comparative evidence between percutaneous pedicle screws (PPS) and cortical bone trajectory (CBT) screws in PETLIF is limited. This retrospective, non-randomized comparative study evaluated short-term outcomes between CBT and PPS fixation, focusing on muscle injury and early postoperative pain. Methods: This retrospective study included 140 patients who underwent single-level PETLIF between July 2021 and June 2025 (PPS: 69; CBT: 71). Allocation to PPS or CBT fixation was based on surgeon preference. Operative time, blood loss, hemoglobin (Hb) and creatine kinase (CK) levels, slip correction, Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) scores for low back pain were evaluated. Direct decompression was performed more frequently in the CBT group. Laboratory data were collected preoperatively and on postoperative days 1, 3, and 7. Results: Blood loss was higher in the CBT group due to more frequent decompression, although postoperative Hb changes were similar. CK elevation on postoperative day (POD) 1 was associated with lower values in the CBT group (753.0 ± 276.7 U/L vs. 539.3 ± 322.4 U/L). Slip correction and JOA improvement were comparable. Early postoperative low back pain (POD 7) was significantly lower in the CBT group (3.2 ± 2.2 vs. 2.3 ± 1.9). Conclusions: CBT fixation in PETLIF was associated with lower short-term muscle injury and early postoperative pain while maintaining radiological and functional outcomes comparable to PPS. However, the higher frequency of direct decompression in the CBT group represents an important potential confounder. This study evaluated only ultra-short-term perioperative outcomes up to 60 days; long-term endpoints such as fusion rate, cage subsidence, screw loosening, and adjacent segment disease were not assessed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.