{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:36:47Z","timestamp":1787755007680,"version":"build-2784847793"},"reference-count":112,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Traditional pedicle screws are currently the gold standard to achieve stable 3-column fixation of the degenerative lumbar spine. However, there are cases in which pedicle screw fixation may not be ideal. Due to their starting point lateral to the pars interarticularis, pedicle screws require a relatively wide dissection along with a medialized trajectory directed toward the centrally located neural elements and prevertebral vasculature. In addition, low bone mineral density remains a major risk factor for pedicle screw loosening, pullout, and pseudarthrosis. The purpose of this article is to review the indications, advantages, disadvantages, and complications associated with posterior fixation techniques of the degenerative lumbar spine beyond the traditional pedicle screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Comprehensive literature searches of the PubMed, Scopus, and Web of Science databases were performed for 5 methods of posterior spinal fixation, including (1) cortical bone trajectory (CBT) screws, (2) transfacet screws, (3) translaminar screws, (4) spinous process plates, and (5) fusion mass screws and hooks. Articles that had been published between January 1, 1990, and January 1, 2020, were considered. Non-English-language articles and studies involving fixation of the cervical or thoracic spine were excluded from our review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After reviewing over 1,700 articles pertaining to CBT and non-pedicular fixation techniques, a total of 284 articles met our inclusion criteria. CBT and transfacet screws require less-extensive exposure and paraspinal muscle dissection compared with traditional pedicle screws and may therefore reduce blood loss, postoperative pain, and length of hospital stay. In addition, several methods of non-pedicular fixation such as translaminar and fusion mass screws have trajectories that are directed away from or posterior to the spinal canal, potentially decreasing the risk of neurologic injury. CBT, transfacet, and fusion mass screws can also be used as salvage techniques when traditional pedicle screw constructs fail.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>CBT and non-pedicular fixation may be preferred in certain lumbar degenerative cases, particularly among patients with osteoporosis. Limitations of non-pedicular techniques include their reliance on intact posterior elements and the lack of 3-column fixation of the spine. As a result, transfacet and translaminar screws are infrequently used as the primary method of fixation. CBT, transfacet, and translaminar screws are effective in augmenting interbody fixation and have been shown to significantly improve fusion rates and clinical outcomes compared with stand-alone anterior lumbar interbody fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.20.00177","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T15:00:17Z","timestamp":1627484417000},"source":"Crossref","is-referenced-by-count":23,"title":["Alternatives to Traditional Pedicle Screws for Posterior Fixation of the Degenerative Lumbar Spine"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9496-1344","authenticated-orcid":false,"given":"Alexander A.","family":"Rosinski","sequence":"first","affiliation":[{"name":"San Francisco Orthopaedic Residency Program, St. Mary\u2019s Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1235-0246","authenticated-orcid":false,"given":"Ashish","family":"Mittal","sequence":"additional","affiliation":[{"name":"San Francisco Orthopaedic Residency Program, St. Mary\u2019s Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4815-4338","authenticated-orcid":false,"given":"Khalid","family":"Odeh","sequence":"additional","affiliation":[{"name":"San Francisco Orthopaedic Residency Program, St. Mary\u2019s Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-8701","authenticated-orcid":false,"given":"Victor","family":"Ungurean","sequence":"additional","affiliation":[{"name":"The Taylor Collaboration, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0490-6005","authenticated-orcid":false,"given":"Jeremi","family":"Leasure","sequence":"additional","affiliation":[{"name":"The Taylor Collaboration, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2136-2495","authenticated-orcid":false,"given":"Connor","family":"Telles","sequence":"additional","affiliation":[{"name":"Sierra Pacific Orthopaedics, Fresno, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3390-6648","authenticated-orcid":false,"given":"Dimitriy","family":"Kondrashov","sequence":"additional","affiliation":[{"name":"San Francisco Orthopaedic Residency Program, St. Mary\u2019s Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,7]]},"reference":[{"issue":"Suppl 2","key":"r1-20230807","first-page":"21","article-title":"Lumbar disc disorders and low-back pain: socioeconomic factors and consequences","volume":"88","author":"Katz","year":"2006","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"r2-20230807","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/00007632-197812000-00004","article-title":"Pathology and pathogenesis of lumbar spondylosis and stenosis","volume":"3","author":"Kirkaldy-Willis","year":"1978","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"r3-20230807","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2019.4.SPINE18915","article-title":"State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease","volume":"31","author":"Reid","year":"2019","journal-title":"J Neurosurg Spine"},{"issue":"23","key":"r4-20230807","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1097\/BRS.0000000000002682","article-title":"Long-term results of surgery compared with nonoperative treatment for lumbar degenerative spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT)","volume":"43","author":"Abdu","year":"2018","journal-title":"Spine (Phila Pa 1976"},{"issue":"6","key":"r5-20230807","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.2106\/JBJS.H.00913","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. 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