Cortical bone trajectory for lumbar pedicle screw placement: a review of published reports

Kevin Phan, Jarred Hogan, Monish Maharaj, Ralph J. Mobbs*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

57 Citations (Scopus)


There have been a number of developments in screw design and implantation techniques over recent years, including proposal of an alternative trajectory for screw fixation aimed at increasing purchase of pedicle screws in higher density bone. Cortical bone trajectory (CBT) screw insertion follows a lateral path in the transverse plane and caudocephalad path in the sagittal plane. This technique has been advocated because it is reportedly less invasive, improves screw-bone purchase and reduces neurovascular injury; however, these claims have not been supported by robust clinical evidence. The available evidence was therefore reviewed to assess the relative merits of CBT and highlight areas for further research. To this end, a search of relevant published studies reporting biomechanical, morphometric or clinical outcomes after use of CBT screws in patients with spinal pathologies was performed via six electronic databases.

Original languageEnglish
Pages (from-to)213-221
Number of pages9
JournalOrthopaedic Surgery
Issue number3
Publication statusPublished - 1 Aug 2015
Externally publishedYes


  • Cortical bone trajectory
  • Cortical screw
  • Medio-lateral superior trajectory
  • Pedicle fixation
  • Pedicle screw


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