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Should we use cortical bone screws for cortical bone trajectory?

Masaki Ueno1, Rina Sakai, Kensei Tanaka

  • 1Department of Orthopaedic Surgery, Kitasato University School of Medicine; and

Journal of Neurosurgery. Spine
|January 17, 2015
PubMed
Summary

Cortical bone trajectory (CBT) significantly increases pedicle screw fixation strength. The study found the unique trajectory, not just screw type, is key for enhanced stability in spinal surgery.

Keywords:
CBT = cortical bone trajectoryPMMA = polymethylmethacrylateTT = traditional trajectorycortical bone trajectorypedicle screwscrew threadspinal fusiontechnique

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Area of Science:

  • Spinal Surgery
  • Orthopedic Biomechanics
  • Spinal Fusion Techniques

Background:

  • Cortical bone trajectory (CBT) offers improved pedicle screw fixation.
  • The contribution of screw thread design versus trajectory to CBT's strength is debated.

Purpose of the Study:

  • To determine if CBT's enhanced fixation strength is due to the trajectory or screw design.
  • To compare pullout strength between CBT and traditional trajectories with different screw types.

Main Methods:

  • Animal model using porcine lumbar vertebrae (L1-L4).
  • Four groups: cancellous/cortical screws in traditional/CBT trajectories.
  • Pullout strength and toggle testing performed.

Main Results:

  • CBT with cortical screws showed significantly greater pullout strength than traditional trajectory with cancellous screws.
  • Cortical screws trended towards higher strength in both trajectories, but not significantly.
  • Toggle testing revealed no significant differences between groups.

Conclusions:

  • The unconventional trajectory of CBT appears to be the primary driver of increased fixation strength.
  • Further research may clarify optimal screw selection for CBT.