title: Lumbar Spinal Fixation with Cortical Bone Trajectory Pedicle Screws in 79 Patients with Degenerative Disease: Perioperative Outcomes and Complications.
abstract: OBJECTIVE
  Biomechanical studies demonstrate that cortical bone trajectory pedicle screws (CBTPS) have greater pullout strength than traditional pedicle screws with a lateral-medial trajectory. CBTPS start on the pars and angulate in a mediolateral-caudocranial direction. To our knowledge, no large series exists evaluating the perioperative outcomes and safety of CBTPS.
  
  
  METHODS
  We retrospectively reviewed all patients who received lumbar CBTPS at our institution. Data were collected regarding patient demographics, use of image guidance, operative blood loss, hospital stay, and postoperative complications.
  
  
  RESULTS
  A total of 79 patients undergoing CBTPS fusion for degenerative lumbosacral disease with back pain were included in the analysis (42 female, 37 male; October 2011-January 2015). Twenty patients (25.3%) had previous lumbar spine surgery, 39 (49.4%) had a smoking history, and mean body mass index was 28.7. Mean length of stay was 3.5 days, and mean operative blood loss was 306.3 mL. Image guidance was used in 69 (87.3%) cases. A total of 66 (83.5%) fusions were single level, and 54 (68.4%) fusions were single level without previous surgery. There were 9 complications in 7 (8.9%) patients; these included hardware failure, pseudarthrosis, deep vein thrombosis, pulmonary embolism, epidural hematoma, and wound infection. No complications were caused by misplaced screws. Mean follow-up was 13.2 months.
  
  
  CONCLUSIONS
  As CBTPS becomes increasingly popular among spine surgeons performing lumbar fusion, this report provides an important evaluation of technique safety and acceptable perioperative outcomes.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Martinez-Del-Campo
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Neal
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Al-Wala
authors.initials: AW
authors.lastname: Awad
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bina
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Ponce
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Taro
authors.initials: T
authors.lastname: Kaibara
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology* / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000295:instrumentation / Q000706:statistics & numerical data*
keywords: Cortical bone trajectory; Cortical pedicle screws; Cortical screws; Fixation; Interbody; Pedicle screw; Posterior spinal fixation; Posterior spinal fusion; Transforaminal