umbar fixation using cortical bone trajectory (CBT) is increasingly popular among spine surgeons. Although some surgeons argue that the trajectory is technically demanding or requires further studies, various advantages are reported. These advantages include smaller incisions and faster operating times, with patient outcomes equivalent to standard pedicle screw use. 1 The prospective study by Arzoglou et al 2 describes 3 years of follow-up for patients who underwent lumbar fixation with CBT screws. Eighty patients with grade 1 spondylolisthesis underwent lumbar fixation by 1 surgeon. Outcomes were measured at 1 and 3 years postoperatively, including Oswestry Disability Index, Visual Analog Scale (back and leg) pain, walking distance, opioid use, and quality-of-life status. All outcome measures had improved by 1 year and remained improved at 3 years compared with preoperative scores.The authors classified patients into 4 groups for analysis: (1) microinstability (facet joint effusion >1.5 mm) but no spondylolisthesis, (2) microinstability with spondylolisthesis, (3) severe foraminal narrowing requiring facetectomy and impending iatrogenic instability regardless of spondylolisthesis, and (4) dynamic instability with spondylolisthesis. The groups had different rates of improvement over time, with some, but not all, continuing to improve between years 1 and 3. Patients in groups 3 and 4 and those with high body mass index sustained postoperative improvement longer than 1 year. This study adds to the body of literature that demonstrates CBT screws are a reasonable alternative to standard pedicle screws in certain patients.Lee et al 3 performed a prospective, randomized trial comparing pedicle and cortical screws in lumbar interbody fusion. CBT screws provided comparable clinical and radiographic outcomes, demonstrating noninferiority. Various reviews have similarly shown equivalent and, at times, superior clinical outcomes for CBT screw fixation compared with traditional pedicle screw fixation. Phan et al 4 reviewed 9 studies and revealed