Paired Biomechanical Comparison of Cortical and Traditional Pedicle Screw Constructs Under Cyclic Loading in a Severely Destabilized Lumbar Spine Model

In a highly destabilized flexion-compression model, CBT and TPS constructs demonstrated similar fatigue performance. CBT screws offered greater resistance to ROM but no significant advantage in construct stiffness or survival. These results suggest that observed clinical failures of CBT may be attributable to surgical technique or placement sensitivity rather than inferior fatigue behavior.