Treatment of Spinal Conditions in Young Adults: Cortical Lumbar Screw Techniques

Cortical screws in the lumbar spine are an alternative to traditional pedicle screw fixation. The starting point is on the dorsal pars and the trajectory is up and out toward the lateral junction of the pedicle with the vertebral body. It allows for a smaller incision and less lateral dissection when compared with pedicle screw placement. Biomechanical studies have shown that cortical screws are equivalent to pedicle screws, and there is limited evidence of improved fixation with this technique in the setting of low bone density. Clinical studies demonstrate equivalent clinical and radiographic results between cortical screw and pedicle screws when used in conjunction with posterior interbody support. The indications, contraindications, surgical technique, special considerations, and literature surrounding the use of lumbar cortical screws are reviewed.