Application of the cortical bone trajectory technique in posterior lumbar fixation

Abstract

The cortical bone trajectory (CBT) is a novel technique in lumbar fixation and fusion. The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method. The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases, including spondylolisthesis or stenosis, and can also be used as a remedy for revision surgery when the pedicle screw fails. CBT has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. However, the concept of CBT internal fixation technology appeared relatively recently; consequently, there are few relevant clinical studies, and the long-term clinical efficacy and related complications have not been reported. Therefore, large sample and prospective studies are needed to further reveal the long-term complications and fusion rate. As a supplement to the traditional pedicle trajectory fixation technique, the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

Keywords: Cortical bone trajectory, Management of midle line fusion, Lumbar interbody fusion, Lumbar surgery, Review

Core Tip: The cortical bone trajectory (CBT) has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. This review presents the biomechanical characteristics, the perioperative osteoporosis management of midle line fusion (MIDLF) surgery, the clinical effect of MIDLF when comparing to other lumbar fusion surgery, the clinical effect of MIDLF for the treatment of lumbar spondylolisthesis, the advantages about MIDLF for spinal revision surgery, and the computer navigation-assisted CBT technique.