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Updated: Jan 27, 2026
05:05
Four-Dimensional CT Analysis Using Sequential 3D-3D Registration
Published on: November 23, 2019
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Preoperative 3D CT Planning for Cortical Bone Trajectory Screws: A Retrospective Radiological Cohort Study
Federica Penner1, Nicola Marengo1, Marco Ajello1
1Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
World Neurosurgery
|March 25, 2019
Summary
Preoperative 3D CT planning reliably guides cortical bone trajectory (CBT) screw placement in lumbar fusion surgery. This technique accurately predicts entry points and trajectories, offering a cost-effective alternative to navigation systems.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Radiology
Background:
- Pedicle screw instrumentation is standard for lumbar spinal fusion.
- Cortical bone trajectory (CBT) screws offer a less invasive alternative but pose placement challenges.
- Accurate entry point and trajectory identification are crucial for CBT screw success.
Purpose of the Study:
- To evaluate the reliability of preoperative computed tomography (CT) planning for cortical bone trajectory (CBT) screw placement.
- To assess the accuracy of 3D multiplanar reconstruction CT in guiding CBT screw insertion.
Main Methods:
- Retrospective analysis of 82 patients undergoing single-level posterior lumbar arthrodesis with CBT screws.
- Preoperative 3D multiplanar reconstruction CT used to identify optimal entry point and trajectory.
- Postoperative CT scans assessed concordance between planned and achieved screw trajectories.
Main Results:
- 328 CBT screws were analyzed.
- Average entry point accuracy was 1.1 mm from the target.
- 91.8% of screws achieved trajectories within 2° of the planned path.
- No screw misplacement or new neurological deficits were reported.
Conclusions:
- CBT screw placement is a viable alternative to traditional pedicle screws.
- Preoperative 3D CT planning provides accurate guidance for CBT screw placement.
- This planning method is comparable to navigation systems, offering a cost-effective and technically simpler solution for customized spine surgery.
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