{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:06:30Z","timestamp":1789499190312,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NSK Nakanishi Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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 \u00b1 276.7 U\/L vs. 539.3 \u00b1 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 \u00b1 2.2 vs. 2.3 \u00b1 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.<\/jats:p>","DOI":"10.3390\/jcm15187174","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:23:53Z","timestamp":1789496633000},"page":"7174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Cortical Bone Trajectory and Percutaneous Pedicle Screw Fixation in PETLIF: Short-Term Perioperative Muscle Injury and Pain Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8844-3476","authenticated-orcid":false,"given":"Daisuke","family":"Ukeba","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Ken","family":"Nagahama","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"},{"name":"Department of Orthopaedic Surgery, Sapporo Endoscopic Spine Surgery, Sapporo 065-0016, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9601-8373","authenticated-orcid":false,"given":"Yoshinori","family":"Hyugaji","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Sapporo Endoscopic Spine Surgery, Sapporo 065-0016, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-5890","authenticated-orcid":false,"given":"Katsuhisa","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8635-4648","authenticated-orcid":false,"given":"Hideki","family":"Sudo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2998-2242","authenticated-orcid":false,"given":"Tsutomu","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9228-7250","authenticated-orcid":false,"given":"Takashi","family":"Ohnishi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Ryo","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-5572","authenticated-orcid":false,"given":"Yoshinao","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6871-2755","authenticated-orcid":false,"given":"Akira","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5496-4046","authenticated-orcid":false,"given":"Norimasa","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/00003086-198901000-00004","article-title":"Percutaneous Lumbar Discectomy. Review of 100 Patients and Current Practice","volume":"238","author":"Kambin","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.22603\/ssrr.2018-0058","article-title":"Early Clinical Results of Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A New Modified Technique for Treating Degenerative Lumbar Spondylolisthesis","volume":"3","author":"Nagahama","year":"2019","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ono, K., Fukuhara, D., Nagahama, K., Abe, Y., Takahashi, K., and Majima, T. (2023). Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PETLIF): Current Techniques, Clinical Outcomes, and Narrative Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165391"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/BSD.0000000000000827","article-title":"Full Percutaneous Transforaminal Lumbar Interbody Fusion Using the Facet-Sparing, Trans-Kambin Approach","volume":"33","author":"Morgenstern","year":"2020","journal-title":"Clin. Spine Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1186\/s13018-025-06265-2","article-title":"Comparison of the Clinical Efficacy of Percutaneous Endoscopic Lumbar Interbody Fusion through Different Surgical Approaches: A Retrospective Study","volume":"20","author":"Feng","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e169","DOI":"10.1016\/j.wneu.2023.06.012","article-title":"Percutaneous Pedicle Screw Fixation with Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Spondylolisthesis with Instability","volume":"177","author":"Cheng","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lin, L., Liu, X.-Q., Shi, L., Cheng, S., Wang, Z.-Q., Ge, Q.-J., Gao, D.-Z., Ismail, A.C., Ke, Z.-Y., and Chu, L. (2022). Comparison of Postoperative Outcomes Between Percutaneous Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.916087"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"460","DOI":"10.22603\/ssrr.2024-0254","article-title":"Comparative Study between Full-Endoscopic Transforaminal Approach Lumbar Interbody Fusion (TF-LIF) Using PETLIF System and Minimally Invasive TLIF for Degenerative Lumbar Spine Disorders","volume":"9","author":"Yamada","year":"2025","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1186\/s13018-025-06073-8","article-title":"Comparative Efficacy of Autologous Iliac Bone versus Allogeneic Demineralized Bone Matrix in Lateral Lumbar Interbody Fusion Using a Novel Minimally Invasive Iliac Bone Retrieval Tool: A Self-Controlled Study","volume":"20","author":"Li","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Elgafy, H., Wetzell, B., Gillette, M., Semaan, H., Rowland, A., Balboa, C.A., Mierzwa, T.A., McLean, J.B., Dorsch, K., and Moore, M.A. (2021). Lumbar Spine Fusion Outcomes Using a Cellular Bone Allograft with Lineage-Committed Bone-Forming Cells in 96 Patients. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04584-z"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1097\/00007632-199505000-00012","article-title":"Iliac Crest Bone Graft Harvest Donor Site Morbidity. A Statistical Evaluation","volume":"20","author":"Banwart","year":"1995","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1055\/s-0035-1558656","article-title":"Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial","volume":"6","author":"Samartzis","year":"2016","journal-title":"Glob. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1097\/01.bsd.0000112045.36255.83","article-title":"Iliac Crest Bone Graft Donor Site Pain after Anterior Lumbar Interbody Fusion: A Prospective Patient Satisfaction Outcome Assessment","volume":"18","author":"Sasso","year":"2005","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ohba, T., Ebata, S., and Haro, H. (2017). Comparison of Serum Markers for Muscle Damage, Surgical Blood Loss, Postoperative Recovery, and Surgical Site Pain after Extreme Lateral Interbody Fusion with Percutaneous Pedicle Screws or Traditional Open Posterior Lumbar Interbody Fusion. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1775-y"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/01.brs.0000148999.21492.53","article-title":"Comparison of Multifidus Muscle Atrophy and Trunk Extension Muscle Strength: Percutaneous versus Open Pedicle Screw Fixation","volume":"30","author":"Kim","year":"2005","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E329","DOI":"10.1097\/BSD.0000000000000651","article-title":"Novel Placement of Cortical Bone Trajectory Screws in the Lumbar Spine: A Radiographic and Cadaveric Study","volume":"31","author":"Gao","year":"2018","journal-title":"Clin. Spine Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Liu, C.-W., Wang, L.-L., Xu, Y.-K., Chen, C.-M., Wang, J.-C., Tsai, W.-T., and Lin, S.-C. (2020). Traditional and Cortical Trajectory Screws of Static and Dynamic Lumbar Fixation\u2014A Finite Element Study. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03437-5"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E240","DOI":"10.1097\/BRS.0000000000000116","article-title":"In Vivo Analysis of Insertional Torque during Pedicle Screwing Using Cortical Bone Trajectory Technique","volume":"39","author":"Matsukawa","year":"2014","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"679","DOI":"10.21037\/jss.2017.11.03","article-title":"Systematic Review of Cortical Bone Trajectory versus Pedicle Screw Techniques for Lumbosacral Spine Fusion","volume":"3","author":"Phan","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.spinee.2008.07.008","article-title":"Cortical Bone Trajectory for Lumbar Pedicle Screws","volume":"9","author":"Santoni","year":"2009","journal-title":"Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"870","DOI":"10.31616\/asj.2018.12.5.870","article-title":"Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion","volume":"12","author":"Elmekaty","year":"2018","journal-title":"Asian Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1411","DOI":"10.1097\/BSD.0000000000000514","article-title":"Clinical Outcomes After Posterior Lumbar Interbody Fusion: Comparison of Cortical Bone Trajectory and Conventional Pedicle Screw Insertion","volume":"30","author":"Takenaka","year":"2017","journal-title":"Clin. Spine Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e821","DOI":"10.1016\/j.wneu.2021.04.130","article-title":"Comparison of Clinical Outcomes After Transforaminal Interbody Fusion Using Cortical Bone Trajectory versus Percutaneous Pedicle Screw Fixation","volume":"151","author":"Maruo","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1177\/21925682251408367","article-title":"Comparative Efficacy and Safety of Minimally Invasive, Full-Endoscopic, and Biportal Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Network Meta-Analysis","volume":"16","author":"Cheng","year":"2026","journal-title":"Glob. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103404","DOI":"10.1016\/j.jcot.2026.103404","article-title":"Comparing percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy in the treatment of lumbar disc herniation: An updated systematic review and meta-analysis of cohort and RCT","volume":"76","author":"Suskhan","year":"2026","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.wneu.2024.10.120","article-title":"Duckbill Release Technique for the Outside-in Method in Full-Endoscopic Spine Surgery via Transforaminal Approach: A Technical Note","volume":"193","author":"Ukeba","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1177\/2192568221989295","article-title":"Factors Affecting Slip Reduction in Oblique Lumbar Interbody Fusion With Posterior Fixation for Degenerative Spondylolisthesis","volume":"12","author":"Chung","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"44565","DOI":"10.1038\/s41598-025-28256-3","article-title":"Radiographic and Clinical Outcomes at 12 Months Following Full Endoscopic Interlaminar Decompression for Grade 1 Degenerative Lumbar Spondylolisthesis","volume":"15","author":"Bayram","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"De Simone, M., Choucha, A., Ciaglia, E., Conti, V., Pecoraro, G., Santurro, A., Puca, A.A., Cascella, M., and Iaconetta, G. (2024). Discogenic Low Back Pain: Anatomic and Pathophysiologic Characterization, Clinical Evaluation, Biomarkers, AI, and Treatment Options. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195915"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"583","DOI":"10.3171\/2023.5.SPINE23116","article-title":"Does low-back pain improve after decompressive spinal surgery? A prospective observational study from the British Spine Registry","volume":"39","author":"Knight","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.3109\/09638288.2015.1107777","article-title":"Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: A systematic review","volume":"38","author":"Gobbo","year":"2016","journal-title":"Disabil. Rehabil."},{"key":"ref_32","first-page":"597","article-title":"Systematic reviews of physical and rehabilitation medicine Cochrane contents: Part 1. Disabilities due to spinal disorders and pain syndromes in adults","volume":"49","author":"Negrini","year":"2013","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1089\/lap.2025.0088","article-title":"Robotic Versus Laparoscopic Surgery for Colorectal Cancer: A Trial Sequential Meta-Analysis of Randomized Trials","volume":"35","author":"Pompeu","year":"2025","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10151-026-03414-5","article-title":"Does robotics add value in Hartmann\u2019s reversal? A PRISMA-based systematic review and meta-analysis of perioperative outcomes","volume":"30","author":"Abdelsamad","year":"2026","journal-title":"Tech. Coloproctol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.3171\/2025.7.SPINE251044","article-title":"Letter to the Editor. Cage subsidence in TLIF: Patient-specific, technique-sensitive predictive models","volume":"44","author":"Amoroso","year":"2025","journal-title":"J. Neurosurg. 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