Work

Traditional pedicle screw versus cortical bone trajectory in the upper thoracic spine: A technical description and retrospective comparative review

Year: 2026

Type: article

Abstract: Background: The cortical bone trajectory (CBT) screw is a relatively new vertebral fixation technique described for use in the lumbar spine by Santoni and Hynes et al. It has been shown to have advantageous biomechanical properties with respect to torsional and pullout strength. The evaluation of CBT in cervical-thoracic fixation has been quite limited. The primary objective of the current study was to determine the mid to long term results of CBT over traditional pedicle screw fixation in the upper thoracic spine. Methods: The current study completed a retrospective chart review of consecutive patients undergoing posterior cervical thoracic fixation in the setting of degenerative, trauma, infection and oncologic etiologies at a single academic centre. Patients with a greater than 1 year radiological follow up were included in the research study. Data was collected by an independent observer, which included patient demographics, complications. Preserved immediate postoperative sagittal alignment at 1 year was considered the primary outcome of this study. Results: Of the 47 patients who met the inclusion criteria, 18 had undergone upper thoracic spine instrumentation with CBT and 28 had TPS trajectories. The operative time was found to be significantly lower in the CBT group (p<.01). The complication rates were similar between groups with the TPS group having an infection rate of 10.7% while the CBT group had a rate of 4.7%. CBT had a higher rate of preservation of post operative alignment at greater than 1 year follow up (p<.05). Conclusions: Patients who underwent CBT fixation had preserved cervical spine alignment at their final postoperative visit. The use of CBT led to a reduction in total length of OR and trended towards a lower complication rate. Given the early findings of our study and others it is likely that CBT screws in the upper thoracic spine will become much more common place at the end of both cervical-thoracic and thoraco-lumbar fusion constructs given their demonstrated benefits.

Source: North American Spine Society Journal (NASSJ)

DOI: 10.1016/j.xnsj.2026.100859