# A Novel Two-Step Method for Converting Lumbar Cortical Screw to Pedicle Screw: A Case Report

## TL;DR

A new two-step surgical method successfully revised failed lumbar fusion hardware using neuronavigation and specialized tools.

## Contribution

A novel two-step technique for converting failed cortical screws to pedicle screws using neuronavigation and specialized instruments.

## Key findings

- The two-step method successfully revised failed L2 and L3 fusion hardware in a patient.
- Neuronavigation and specialized tools enabled safe screw placement through old cortical trajectories.
- This approach addresses challenges of CBT hardware failure and pseudoarthrosis.

## Abstract

The cortical bone trajectory (CBT) technique has emerged as a minimally invasive approach for lumbar fusion but may result in pseudoarthrosis and hardware failure. This report presents a case of successful pedicle screw revision in a patient with previous failed L2 and L3 fusion using a novel "two-step" technique, including (1) drilling a new trajectory with Medtronic EM800N Stealth MIDAS Navigated MR8 drill system (Medtronic, Dublin, Ireland) and (2) placement of Solera 4.75 ATS (awl-tapped screws) with navigated POWEREASE™ (Medtronic), described here for the first time. This method involves utilizing neuronavigation and specialized instruments to safely place pedicle screws through the path of the old cortical screw trajectory, addressing the challenges associated with CBT hardware failure.