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BACKGROUND: Bone grafting is one of the important steps in the treatment of thoracolumbar burst fractures. Because the fracture involves the spinal canal or is accompanied by spinal cord nerve damage, severe fracture bleeding and other factors, minimally invasive bone grafting for thoracolumbar burst fractures is restricted. At present, the minimally invasive treatment of thoracolumbar burst fractures is limited to percutaneous screw fixation under the tunnel. Minimally invasive percutaneous bone grafting of injured vertebrae is rarely reported, and percutaneous precise bone grafting under the endplate has not yet been reported. OBJECTIVE: To investigate the clinical effect of subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fractures. METHODS: From June 2017 to December 2021, 90 patients with A3+B2 type asymptomatic thoracolumbar burst fracture were randomly divided into 3 groups according to admission time. In group A, 33 patients received the bone graft funnel accurately placed through the pedicle channel by percutaneous puncture under C-arm fluoroscopy, bone graft support reduction under the fracture endplate, percutaneous pedicle screw fixation. In group B, 30 patients received multifissure intermuscular approach through pedicle bone graft support reduction combined with pedicle screw fixation. In group C, 27 patients received percutaneous pedicle screw short-segment fixation under postural reduction. All patients were followed up for at least 18 months after surgery. The clinical data of the three groups, including preoperative, postoperative and last follow-up Cobb angle, anterior edge height ratio and visual analog scale pain score, were compared and analyzed. RESULTS AND CONCLUSION: (1) There were no significant differences in age, sex, injury segment and causative factors among the three groups (P > 0.05). (2) All patients at follow-up had no neurological impairment, no obvious lumbar posterior deformity or intractable low back pain. (3) The operation time of group C was less than that of group A and group B (P < 0.05). Intraoperative blood loss was less in group A and group C than in group B (P < 0.05). (4) There were no significant differences in the anterior edge height ratio and Cobb angle among the three groups (P > 0.05). Postoperative data in groups A and B were better than that in group C. At last follow-up, group A and group B outperformed group C (P < 0.05). The height and Cobb angle of the vertebral body lost in the three groups were smaller in groups A and B than those in group C (P < 0.05). (5) Visual analog scale pain score was better in groups A and C than that in group B after surgery (P < 0.05). There was no significant difference in visual analog scale pain score among the three groups at last follow-up (P > 0.05). (6) In group C, there was one case of loose internal fixation and displacement in 1 month after surgery, and the vertebral height was lost again with back pain, and after strict bed rest for 6 weeks, the vertebral height loss was not aggravated, the pain was relieved, and the internal fixation was removed after 1 year, and the height loss at the last follow-up was not aggravated. There were no cases of failure of internal fixation in groups A and B. (7) It is indicated that subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fracture has the advantages of less trauma, less bleeding and light postoperative pain symptoms, and the effect of injury vertebral reduction and height maintenance is the same as the reduction through pedicle bone grafting support and short segment fixation with pedicle screws through the multifidus space approach. [ABSTRACT FROM AUTHOR]

Objective. To examine the shape change of screw-rod constructs over time after short-segment lumbar interbody fusion and to clarify its relationship to clinical characteristics. Summary of Background Data. No study has focused on the shape change of screw-rod constructs after short-segment fusion and its clinical implications. Methods. One hundred eight patients who had single-level lumbar interbody fusion with pedicle screws and cages were enrolled. Three-dimensional (3D) images of screw-rod constructs were generated from baseline CT on the day after surgery and followup CT and were superposed on the right and left side, respectively, using the iterative closest point algorithm. The shape change was quantitatively assessed by computing the median distance between the 3D images, which was defined as the shape change value. Among the 5 time-course categories of follow-up CT (=1, 2-3, 4-6, 7-12, and =13 months), the shape change values were compared. The relationships between the shape change values and clinical characteristics, such as age, CT-derived vertebral bone mineral density, screw and rod materials, and postoperative interbody fusion status, cage subsidence, and screw loosening, were evaluated. Results. A total of 237 follow-up CTs were included (=1 [34 scans], 2-3 [33 scans], 4-6 [80 scans], 7-12 [48 scans], and = 13 months [42 scans]) because many patients underwent multiple follow-up CTs. There were significant differences in shape change values among the time-course categories (P<0.001 in Kruskal-Wallis test). Most shape changes occurred within 6 months postoperatively, with no significant changes observed at 7 months or more. There were no significant relationships between the shape change values and each clinical characteristic. Conclusions. The temporal shape changes of screw-rod constructs following short-segment lumbar interbody fusion progressed up to 6 months after surgery but not significantly thereafter. [ABSTRACT FROM AUTHOR]

To investigate the biomechanical properties of pedicle screw reinsertion along the same trajectory in a previously validated synthetic bone model. Twenty identical acrylonitrile butadiene styrene models of lumbar vertebrae were three-dimensional-printed. Screws were placed in the standard fashion into each pedicle. Models were separated into 2 equal groups, control and experimental. Experimental group screws were completely removed from their testing block and reinserted once. All screws in both groups were then forcibly removed. Continuous torque monitoring was collected on screw insertion torque (IT), removal torque, and reinsertion torque. Pullout strength (PO), screw stiffness (STI), and strain energy (STR) were calculated. There was no significant difference between control and experimental groups for PO (P = 0.26), STI (P = 0.55), STR (P = 0.50), or IT (P = 0.24). There was a significant decrease in reinsertion torque (54.5 N-cm ± 8.2 N-cm) from control IT (62.9 N-cm ± 8.4 N-cm, P = 0.045) and experimental IT (67.5 N-cm ± 7.6 N-cm, P = 0.0026). Strong correlations (Pearson's r > 0.80) were seen between control IT against STR and PO, between each of the experimental torque measurements, and between experimental PO and STI. Despite a significant decrease in insertion torque, there is no significant loss of pedicle screw performance when a screw is removed and reinserted along the same trajectory. [ABSTRACT FROM AUTHOR]

Screw loosening is a common complication of pedicle screw internal fixation surgery. This study aimed to investigate whether the application of a porous scaffold structure can increase the contact area between screws and bone tissue by comparing the bone ingrowth and screw-bone interface of porous scaffold core pedicle screws (PSCPSs) and hollow lateral hole pedicle screws (HLHPSs) in the lumbar spine of Bama pigs. Sixteen pedicle screws of both types were implanted into the bilateral pedicles of the L1–4 vertebrae of 2 Bama pigs. All Bama pigs were sacrificed and the lumbar spine was freed into individual vertebrae at 16 weeks postoperatively. After the vertebrae were made into screw-centered specimens, micro-computed tomography analysis and histological observation were performed to assess the screw-bone interface and bone growth around and within the screws. We found that the bone condition around PSCPSs and HLHPSs did not show significant differences on micro-computed tomography three-dimensional reconstruction images. CT transverse views showed different bone growth inside the 2 screws. In PSCPSs, bone tissue was seen to fill the internal pores and was evenly distributed around each strut. Inside HLHPSs, bone growth was confined to 1 side of the screw and did not fill the entire cavity. Osteometric analysis showed that bone volume fraction and trabecular number, the parameters representing bone mass, were higher in PSCPSs than in HLHPSs. These differences were not statistically significant (P > 0.05). Histological observations visualized that the osseointegration within PSCPSs was superior to that of HLHPSs, and the tight integration of bone tissue with the porous scaffold resulted in a larger screw-bone integration area in PSCPSs than in HLHPSs. Compared with HLHPSs, PSCPSs possessing a porous scaffold core could promote bone ingrowth and osseointegration, resulting in an effective enhancement of the combined area of the screw-bone interface. [ABSTRACT FROM AUTHOR]

To compare the stability of a corticopedicular posterior fixation (CPPF) device with traditional pedicle screws for decompression and fusion in adult degenerative lumbar spondylolisthesis. Finite element analysis (FEA) was used in a validated model of grade 1 L4–L5 spondylolisthesis to compare segmental stability after laminectomy alone, laminectomy with pedicle screw fixation, or laminectomy with CPPF device fixation. A 500-N follower load was applied to the model and different functional movements were simulated by applying a 7.5-Nm force in different directions. Outcomes included degrees of motion, tensile forces experienced in the CPPF device, and stresses in surrounding cortical bone. At maximum loading, laminectomy alone demonstrated a 1° increase in flexion range of motion, from 6.35° to 7.39°. Laminectomy with pedicle screw fixation and CPPF device fixation both reduced spinal segmental motion to ≤1° at maximum loading in all ranges of motion, including flexion (0.94° and 1.09°), extension (–0.85° and –1.08°), lateral bending (–0.56° and –0.96°), and torsion (0.63° and 0.91°), respectively. There was no significant difference in segmental stability between pedicle screw fixation and CPPF device fixation during maximum loading, with a difference of ≤0.4° in any range of motion. Tensile forces in the CPPF device remained ≤51% the ultimate load to failure (487 N) and stress in surrounding cortical bone remained ≤84% the ultimate stress of cortical bone (125.4 MPa) during maximum loading. CPFF fixation demonstrated similar segmental stability to traditional pedicle screw fixation whereas tensile forces and stress in surrounding cortical bone remained below the load to failure. [ABSTRACT FROM AUTHOR]

Objective: For degenerative diseases accompanied by cervical malalignment, the starting and ending points of fixation for better cervical sagittal alignment and clinical results are not as clear as the thoracolumbar region. In this study we aimed to compare the effects of posterior subaxial cervical fixation (PSCF), posterior cervical fixation extending to the upper thoracic region and posterior upper cervical fixation extending to the upper thoracic region on cervical sagittal alignment. Methods: Sixty‐three patients who underwent posterior cervical and cervical‐up thoracic fixation were retrospectively analyzed in a comparative study. The procedures that we performed from May 2019 to March 2022 on these 63 patients were: (1) C3‐C6 group—posterior subaxial cervical fixation; (2) Subaxial‐T2 group—posterior subaxial cervicothoracic fixation (PSCTF); (3) C2‐T2 upper thoracic posterior fixation group. The C3‐C6 group had 27 patients, Subaxial‐T2 group had 24, and C2‐T2 group had 12. We determined the minimum follow‐up period as 12 months. C0‐2, C2‐7 lordosis angle, sagittal vertical axis (SVA), C2 slope, C7 slope, T1 slope, cervical slope, neck slope, and thoracic inlet angle (TIA) measurements were made in three patient groups. Comparatively, cervical sagittal alignment was evaluated. Result: In the C2‐T2 group, a significant increase in C2‐C7 lordosis, decrease in C2 slope, and increase in TS‐CL were observed. Significant C2‐C7 lordosis decrease, C2 slope increase, and TS‐CL decrease were observed in the C3‐C6 group. A significant increase in C2‐C7 lordosis and a decrease in C2 slope were observed in the subaxial‐T2 group. No significant change was observed in the TS‐CL angle. Conclusion: In cervical degenerative disorders accompanied by cervical malalignment, we recommend the C2‐T2 fixation method, which provides the desired C2‐C7 lordosis, SVA within the normal range, and the best Neck Disability Index results. [ABSTRACT FROM AUTHOR]

Robotic spine surgery, utilizing 3D imaging and robotic arms, has been shown to improve the accuracy of pedicle screw placement compared to conventional methods, although its superiority remains under debate. There are few studies evaluating the accuracy of 3D navigated versus robotic-guided screw placement across lumbar levels, addressing anatomical challenges to refine surgical strategies and patient safety. This study aims to investigate the pedicle screw placement accuracy between 3D navigation and robotic arm-guided systems across distinct lumbar levels. A retrospective review of a prospectively collected registry. Patients undergoing fusion surgery with pedicle screw placement in the prone position, using either via 3D image navigation only or robotic arm guidance. Radiographical screw accuracy was assessed by the postoperative computed tomography (CT) according to the Gertzbein-Robbins classification, particularly focused on accuracy at different lumbar levels. Accuracy of screw placement in the 3D navigation (Nav group) and robotic arm guidance (Robo group) was compared using Chi-squared test/Fisher's exact test with effect size measured by Cramer's V, both overall and at each specific lumbosacral spinal level. A total of 321 patients were included (Nav, 157; Robo, 189) and evaluated 1210 screws (Nav, 651; Robo 559). The Robo group demonstrated significantly higher overall accuracy (98.6 vs 93.9%; p<.001, V=0.25). This difference of no breach screw rate was signified the most at the L3 level (No breach screw: Robo 91.3 vs 57.8%, p<.001, V=0.35) followed by L4 (89.6 vs 64.7%, p<.001, V=0.28), and L5 (92.0 vs 74.5%, p<.001, V=0.22). However, screw accuracy at S1 was not significant between the groups (81.1 vs 72.0%, V=0.10). This study highlights the enhanced accuracy of robotic arm-guided systems compared to 3D navigation for pedicle screw placement in lumbar fusion surgeries, especially at the L3, L4, and L5 levels. However, at the S1 level, both systems exhibit similar effectiveness, underscoring the importance of understanding each system's specific advantages for optimization of surgical complications. [ABSTRACT FROM AUTHOR]

Thread shape is regarded as an important factor influencing the fixation strength and osseointegration of bone screws. However, commercial pedicle screws with a V-shaped thread are prone to generating stress concentration at the bone-screw interface, thereby increasing the risk of screw loosening. Thus, modification of the pedicle-screw thread is imperative. This study aimed to investigate the fixation stability of pedicle screws with the new undercut thread design in comparison to pedicle screws with a V-shaped thread. In vitro cadaveric biomechanical test and finite element analysis (FEA). Pedicle screws with the undercut thread (characterized by a flat crest feature and a tip-facing undercut feature) were custom-manufactured, whereas those with the V-shaped thread were procured from a commercial supplier. Fixation stability was assessed by the cyclic nonpullout compressive biomechanical testing on cadaveric female osteoporotic vertebrae. The vertical displacement and rotation angle of the 2 types of pedicle screws were calculated every 100 cycles to evaluate their resistance to migration and rotation. FEA was conducted to investigate the stress distribution and bone damage at the bone-screw interface for both types of pedicle screws. Biomechanical testing revealed that the pedicle screws with the undercut thread exhibited significantly lower vertical displacement and rotation angles than the pedicle screws with the V-shape thread (p <0.05). FEA results demonstrated a more uniform stress distribution in the bone surrounding the thread in the undercut design than in the V-shape design. Additionally, bone damage resulting from the pedicle screw was lower in the undercut design than in the V-shape design. Pedicle screws with an undercut thread are less prone to migration and rotation and thus more stable in the bone than those with a V-shape thread. The undercut thread design may reduce the incidence of pedicle-screw loosening. [ABSTRACT FROM AUTHOR]

The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low‐radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery. [ABSTRACT FROM AUTHOR]

Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS(back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise. [ABSTRACT FROM AUTHOR]

Objective: To propose a screw algorithm and investigate the anatomical feasibilities and clinical outcomes of five distinct fixation methods for C2-3 fused vertebra with high-ridding vertebral arteries (VA) (HRVA) when the C2 pedicle screw placement is unfeasible. Methods: Thirty surgical patients with congenital C2-3 fusion, HRVA, and atlantoaxial dislocation (AAD) were included. We designed a algorithm for alternative screw implantation into C2-3 fused vertebrae, including C2 pedicle screw with in-out-in (passing VA groove) technique (in-out-in screw), subfacetal screw, translaminar screw, lateral mass screw, C3 pedicle screw. VA diameter and position, C2 and C3 pedicles, superior facets, fused lamina, and fused lateral mass dimensions were evaluated for screw implantation indication. Implant failure, reduction loss, implant placement accuracy were investigated by computed tomography. Results: A total of 5 VAs were identified as distant VAs; a total of 2 VAs were categorized as occlusive VAs. Sufficient dimension of lateral mass and lamina provided the broadest indications for screw implantation, while the distant or occlusive VA provided the most limited indications for in-out-in screw. The indications of five alternative methods ranged from narrowest to widest as follows: in-out-in screw, C3 pedicle screw, subfacetal screw, translaminar screw, lateral mass screw. The translaminar screws and the lateral mass screws increased the probability of implant failure. All patients who received in-out-in screws, C3 pedicle screws, and subfacetal screws achieved fusion. The accuracy ranged from lowest to highest as follows: C3 pedicle screw, lateral mass screw, in-out-in screw, subfacetal screw, translaminar screw. No translaminar screws deviated. Conclusions: The algorithm proved to be a valuable tool for screw selection in cases of C2-3 fused vertebrae with HRVAs. The subfacetal screw, boasting broad indications, a high fusion rate, and exceptional accuracy, stood as the primary preferred alternative. [ABSTRACT FROM AUTHOR]

(1) Background: Our team has previously introduced the Single-Step Pedicle Screw System (SSPSS), which eliminates the need for K-wires, as a safe and effective method for percutaneous minimally invasive spine (MIS) pedicle screw placement. Despite this, there are ongoing concerns about the reliability and accuracy of screw placement in MIS procedures without traditional tools like K-wires and Jamshidi needles. To address these concerns, we evaluated the accuracy of the SSPSS workflow by comparing the planned intraoperative screw trajectories with the final screw positions. Traditionally, screw placement accuracy has been assessed by grading the final screw position using postoperative CT scans. (2) Methods: We conducted a retrospective review of patients who underwent lumbar interbody fusion, using intraoperative 3D navigation for screw placement. The planned screw trajectories were saved in the navigation system during each procedure, and postoperative CT scans were used to evaluate the implanted screws. Accuracy was assessed by comparing the Gertzbein and Robbins classification scores of the planned trajectories and the final screw positions. Accuracy was defined as a final screw position matching the classification of the planned trajectory. (3) Results: Out of 206 screws, 196 (95%) were accurately placed, with no recorded complications. (4) Conclusions: The SSPSS workflow, even without K-wires and other traditional instruments, facilitates accurate and reliable pedicle screw placement. [ABSTRACT FROM AUTHOR]

Accurate pedicle screw placement is a challenge with reported misplacement rates of 10% and higher. A handheld navigation device (HND) may provide accuracy equal to CT-based navigation (CT-Nav) but without the cost and complexity. To study the accuracy of a handheld navigation device for pedicle screw placement. This prospective cross-sectional study with consistently applied reference standard enrolled 20 patients undergoing 92 pedicle screw placements. Patients who underwent pedicle screw placement between May 2022 and September 2022. Pedicle screw placement accuracy per Gertzbein–Robbins. Once the screw pilot hole was established, the proposed trajectory of the HND was compared with that proposed by CT-Nav. Postoperatively, screw accuracy was graded according to Gertzbein–Robbins by a blinded radiologist based on CT scans. Accuracy was compared between the two systems and published control for fluoroscopy assisted and CT-Nav placement using Bayesian posterior distribution. The trajectory proposed by the HND and CT-Nav were in agreement in 98.9% (95% Exact CI; 94.09%–99.97%). The HND accuracy was 98.9% with 91 screws rated "A" and 1 rated "C". Noninferiority to fluoroscopic placement was achieved because the one-sided normal-approximation 95% CI Lower Bound (LB) of 95.3% is greater than the Performance Goal (PG) of 83.4%. Posthoc analysis demonstrated that the probability of superiority of the HND relative to the historical accuracy rate of 91.5% for fluoroscopy assisted procedures is >0.999 and that the HND's accuracy rate is within 4.5% of CT-Nav of 95.5% is >0.999. No adverse events or intra-operative complications associated with HND were observed. There was 1 (1.1%) intra-operative repositioning and no reoperations for any reason. The accuracy rate of the HND was 98.9%, and the proposed trajectory matched with CT-Nav in 98.9% of the time. This is superior to the historical published accuracy rate for fluoroscopy-assisted procedures and equivalent to the historical published accuracy rate for CT-Nav. Dutch trial register NL74268.058.20. [ABSTRACT FROM AUTHOR]

Long-segment pedicle screw instrumentation is widely used to treat complex spinal disorders. Rods are routinely precontoured to maximize assistance on the correcting side of the deformity, but there often exists a residual gap discrepancy between the precontoured rods and screw tulips. No previous research has investigated the diminished pullout strength of the most proximal or distal pedicle screw resulting from a mismatched rod in long-segment pedicle screw instrumentation. The present study aimed to investigate the decreased pullout force of pedicle screws affected by the gap discrepancy when forcefully engaging a mismatched rod into a tulip in a normal-density porcine spine. The pedicle screw fixation strength under axial pullout force was compared among three different gap discrepancies between rods and tulips using long porcine spine segments. Twelve porcine lumbar vertebrae (L3–L6) were implanted with pedicle screws and rods. Screws on one side had no gap between the tulip and rod (0-mm group), while the most proximal screw on the other side had an intentional gap of 3 mm (3-mm group) or 6 mm (6-mm group). Three hours after forcefully engaging the rod into the tulips at room temperature, the set screws in all specimens were loosened, and each specimen was dissected into individual vertebrae for subsequent pullout testing. The control group exhibited significantly greater pullout strength (1987.68 ± 126.80 N) than the groups from different rod-tulip configurations (p<.05), with significantly greater strength in the 3-mm group (945.62 ± 97.43 N) than the 6-mm group (655.30 ± 194.49 N) (p<.05). Only 47.6% and 33.0% of the pullout strength was retained in the 3-mm and 6-mm groups, respectively, compared to the control group. Gap discrepancies between rods and tulips can significantly reduce pedicle screw pullout strength, with a correlation between decreased strength and increased gaps. Surgeons should avoid forcefully engaging mismatched rods and consider well-fitted contoured rods in spinal surgery to minimize the risk of screw loosening. The gap discrepancy between rod and tulip significantly affected pullout strength, with greater gaps leading to reduced strength. Forcefully engaging mismatched rods into tulips in degenerative spinal surgery should be avoided to minimize the risk of early screw pullout. [ABSTRACT FROM AUTHOR]

Abstract Background To study the risk factors associated with misplacement of freehand pedicle screws through a posterior approach for degenerative scoliosis. Methods A total of 204 patients who underwent posterior pedicle screw-rod system surgery for degenerative scoliosis in our hospital from December 2020 to December 2023 were retrospectively analyzed. Patient demographics, radiographic accuracy, and surgery-related information were recorded. Results A total of 204 patients were included. A total of 2496 screws were placed. 2373 (95.07%) were in good position. Misplacement screws were 123 (4.93%). None of the patients had postoperative spinal nerve symptoms due to screw malposition. The misplacement rate of thoracic (T10-T12) pedicle screws was 11.11% (60/540). Misplacement of pedicle screws in the lumbar spine (L1-L5) was 3.22% (63/1956). Age, gender, surgeon, and operation time had no significant effect on misplacement of pedicle screws (P>0.05). Body mass index, Hu value, number of screw segments, Cobb angle, vertebral rotation, and spinal canal morphology had some correlation with pedicle screw misplacement. Among them, BMI, Hu value, number of screw segments, Cobb angle, and vertebral rotation grade were independent risk factors for PS misplacement (P

Objective For degenerative diseases accompanied by cervical malalignment, the starting and ending points of fixation for better cervical sagittal alignment and clinical results are not as clear as the thoracolumbar region. In this study we aimed to compare the effects of posterior subaxial cervical fixation (PSCF), posterior cervical fixation extending to the upper thoracic region and posterior upper cervical fixation extending to the upper thoracic region on cervical sagittal alignment. Methods Sixty‐three patients who underwent posterior cervical and cervical‐up thoracic fixation were retrospectively analyzed in a comparative study. The procedures that we performed from May 2019 to March 2022 on these 63 patients were: (1) C3‐C6 group—posterior subaxial cervical fixation; (2) Subaxial‐T2 group—posterior subaxial cervicothoracic fixation (PSCTF); (3) C2‐T2 upper thoracic posterior fixation group. The C3‐C6 group had 27 patients, Subaxial‐T2 group had 24, and C2‐T2 group had 12. We determined the minimum follow‐up period as 12 months. C0‐2, C2‐7 lordosis angle, sagittal vertical axis (SVA), C2 slope, C7 slope, T1 slope, cervical slope, neck slope, and thoracic inlet angle (TIA) measurements were made in three patient groups. Comparatively, cervical sagittal alignment was evaluated. Result In the C2‐T2 group, a significant increase in C2‐C7 lordosis, decrease in C2 slope, and increase in TS‐CL were observed. Significant C2‐C7 lordosis decrease, C2 slope increase, and TS‐CL decrease were observed in the C3‐C6 group. A significant increase in C2‐C7 lordosis and a decrease in C2 slope were observed in the subaxial‐T2 group. No significant change was observed in the TS‐CL angle. Conclusion In cervical degenerative disorders accompanied by cervical malalignment, we recommend the C2‐T2 fixation method, which provides the desired C2‐C7 lordosis, SVA within the normal range, and the best Neck Disability Index results.

Introduction: Pedicle screw placement plays a crucial role in treating various cases such as fractures, scoliosis, degenerative spine issues, and kyphosis, reinforcing all three spinal columns simultaneously. While three-dimensional navigation-assisted pedicle screw placement is considered superior, the freehand technique relies on anatomical landmarks and tactile feedback, with observed low complication rates. MATERIALS AND METHODS: This was a prospective single-center study conducted over a period of 3 years. It included all patients of dorsal, lumbar, and sacral spinal instability of myriad etiology. Previously operated patients and sick obtunded patients were excluded from the study. Results: In our study, we included 102 patients including 62 (60.7%) males and 40 (39.2%) females. More than half of patients were young in the age group of 20–50 years. Our study population had a varied etiology with 43.1% of patients having vertebral column instability due to trauma. The other etiologies were spondylolisthesis and lumbar canal stenosis (39.2%), Pott’s spine (11.7%), tumors (2.9%), and osteoporotic fractures (2.9%). Majority of patients (44.1%) presented with lower backache with radiculopathy. All the transpedicular screws inserted were evaluated by C-arm to assess for screw fixation. In the first year of our study, an average of 4 anteroposterior (AP) and 4 lateral C-arm X-ray shots were taken per screw placement. In the next year, an average of 3 AP and 3 lateral shots and finally in the last year of our study only 2 AP and 2 lateral C-arm X-ray shots were taken per screw placement. Out of 650 screws placed, 4 screws were identified to cause breach with maximum breaches in the lumbar spine fixation. In dorsal spine fixation, there was 1 lateral breach at D10. In lumbar spine fixation, there were 3 breaches: two medial one each at L4 and L5 and one anterior at L2 level. The various complications include wound infection, temporary and permanent neurological deficit, screw breakage, screw misplacement, cerebrospinal fluid leaks, nonunion, and spinal epidural hematoma. Conclusions: Our study has provided strong encouragement to persist with the freehand technique in transpedicular fixation surgeries after a certain number of cases given the minimal breaches and complications observed. There are subtle technical nuances as we increase the number of cases with less exposure of anatomical landmarks and X-rays. Success hinges on experience, adherence to technique, and thorough preoperative planning. Further research and extended follow-up periods are necessary to firmly establish this technique as the gold standard.

Introduction: Pedicle screws are commonly used in fixation to treat various spinal disorders. However, screw loosening is a prevalent complication, particularly in patients with osteoporosis. Various biomechanical studies have sought to address this issue, but the optimal depth and trajectory to increase the fixation strength of pedicle screws remain controversial. Therefore, a biomechanical study was conducted using finite element models. Methods: Three-dimensional finite element models of the L3 vertebrae were developed from the preoperative computed tomography images of nine patients with osteoporosis and nine patients without who underwent spine surgery. Unicortical and bicortical pedicle screws were inserted into the center and into the anterior wall of the vertebrae, respectively, in different trajectories in the sagittal plane: straightforward, cephalad, and caudal. Subsequently, three different external loads were applied to each pedicle screw at the entry point: axial pullout, craniocaudal, and lateromedial loads. Nonlinear analysis was conducted to examine the fixation strength of the pedicle screws. Results: Irrespective of osteoporosis, the bicortical pedicle screws had greater fixation strength than the unicortical pedicle screws in all trajectories and external loads. The fixation strength of the bicortical pedicle screws was not substantially different among the trajectories against any external loads in the nonosteoporotic vertebrae. However, the fixation strength of the bicortical pedicle screws against craniocaudal load in the cephalad trajectory was considerably greater than those in the caudal (P=0.016) and straightforward (P=0.023) trajectories in the osteoporotic vertebrae. However, this trend was not observed in pullout and lateromedial loads. Conclusions: Our results indicate that bicortical pedicle screws should be used, regardless of whether the patient has osteoporosis or not. Furthermore, pedicle screws should be inserted in the cephalad trajectory in patients with osteoporosis.

Abstract Background This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient’s financial situation, their ability to tolerate surgery, and the surgeon’s expertise.

BACKGROUND: Atlantoaxial dislocation, because of its high difficulty and high risk of surgery, has been regarded as the “surgical restricted area” by the international orthopedic community. However, with the rapid development of intelligent digitization in orthopedics, robot-assisted navigation screw placement technology has been widely used in clinical practice, which significantly reduces the difficulty and risk of surgery and improves the safety of surgery. However, there are few reports on the application of this technique in the treatment of atlantoaxial dislocation. OBJECTIVE: To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation. METHODS: The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed. Operation time, length of neck incision, blood loss, postoperative drainage volume, and length of hospital stay were recorded. Attention should be paid to cerebrospinal fluid leakage, vertebral artery injury, nerve injury, operative area infection and other complications. The visual analog scale score of neck pain, the spinal cord injury grade of the American Spinal Injury Association, the cervical spine score of the Japanese Orthopaedic Association, and the imaging indicators were collected before surgery and at the last follow-up. Screw placement accuracy was assessed. RESULTS AND CONCLUSION: (1) Five patients were successfully completed surgery, without vascular, nerve injury or other complications, and were followed up for 12-20 months. (2) A total of 20 cervical pedicle screws were placed in 5 patients, including 9 type A screws, 10 type B screws, and 1 type C screw. The accuracy of screw placement was 95%. (3) At the last follow-up, the visual analog scale score was (0.80±0.71) points, which was significantly lower than that before operation (4.00±2.83) points; the Japanese Orthopaedic Association score was (14.80±0.84) points, which was significantly higher than that before operation (8.00±0.71) points. Anterior atlantodental interval decreased from (7.86±3.25) mm to (2.82±0.93) mm; space available of the spinal cord increased from (6.74±1.99) mm to (12.10±3.51) mm; cervicomedullary angle increased from (133.32±13.55)° to (153.44±9.53)°; clivus-canal angle increased from (128.02±9.92)° to (143.25±12.99)°. The results of the last follow-up indexes were improved compared with those before operation, and the differences were significant (all P < 0.05). (4) Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area, and no internal fixation loosening, fracture or pull-out occurred. (5) This method can avoid relying on the doctor’s experience and hand feeling, ensure the accuracy of upper cervical screw placement, reduce the risk of surgery, and obtain satisfactory results in mid-term follow-up. [ABSTRACT FROM AUTHOR]

Abstract Background Screw loosening is a commonly reported issue following spinal screw fixation and can lead to various complications. The initial cause of screw loosening is biomechanical deterioration. Previous studies have demonstrated that modifications in screw design can impact the local biomechanical environment, specifically the stress distribution on bone-screw interfaces. There are several different designs of screw tips available for clinically used pedicle screws; however, it remains unclear whether these variations affect the local stress distribution and subsequent screw anchorage ability. Methods This study conducted comprehensive biomechanical research using polyurethane foam mechanical tests and corresponding numerical simulations to investigate this topic. Models of pedicle screw-fixed osteoporotic polyurethane foam were created with two different clinically used screw tip designs (flat and steep) featuring varying tip lengths, taper angles, and diameters, as well as identical flank overlap areas and thread designs. The anchorage ability of the different models was assessed through toggle and pull-out test. Additionally, numerical mechanical models were utilized to compute the stress distributions at the screw and bone-screw interfaces in the different models. Results Mechanical tests revealed superior anchorage ability in models utilizing flat-tipped screws. Furthermore, numerical modeling indicated improved anchorage ability and reduced stress concentration tendency in these models. Conclusion Changes in screw tip design can significantly impact the biomechanical anchoring capability of screws. Specifically, flatter tip pedicle screws may mitigate the risk of screw loosening by alleviating stress concentration on bone-screw interfaces.

Abstract Objective The aim of this study is to evaluate the clinical efficacy of injectable cemented hollow pedicle screw (CICPS) in the treatment of osteoporotic lumbar degenerative diseases through a large sample long-term follow-up study. Additionally, we aim to explore the risk factors affecting interbody fusion. Methods A total of 98 patients who underwent CICPS for transforaminal lumbar interbody fusion (TLIF) for osteoporotic lumbar degenerative disease from March 2011 to September 2017 were analyzed. X-ray and electronic computed tomography (CT) imaging data were collected during preoperative, postoperative, and follow-up periods. The data included changes in intervertebral space height (ΔH), screw failure, cement leakage (CL), and intervertebral fusion. The patients were divided into two groups based on their fusion status one year after surgery: satisfied group A and dissatisfied group B. Surgical data such as operation time, intraoperative bleeding volume and surgical complications were recorded, and visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the improvement of lumbar and leg pain. Results The mean follow-up time was 101.29 months (ranging from 70 to 128 months). A total of 320 CICPS were used, with 26 screws (8.13%) leaking, 3 screws (0.94%) experiencing cement augmentation failure, and 1 screw (0.31%) becoming loose and breaking. The remaining screws were not loose or pulled out. Female gender, decreased bone density, and CL were identified as risk factors affecting interbody fusion (P

Objective Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. Methods Thirty‐two pedicle screws of both types were implanted bilaterally into the L1–4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull‐out tests, as well as cyclic bending and pull‐out tests, while the mechanical properties were assessed using three‐point bending tests. The data generated were statistically analyzed using paired‐sample t‐tests and two independent sample t‐tests. Results We found that the maximal pull‐out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p 0.05 and p > 0.05, respectively). Additionally, both screws buckled rather than broke in the three‐point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). Conclusions Compared with the HLHPSs, the PSCPSs have greater pull‐out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation.

Objective Thoracolumbar compression fractures resulting from high‐energy injuries are a common type of spinal fracture. Satisfying reduction of compressive vertebra body is essential for the clinical outcome. However, traditional distraction technique may lead to complications including pedicle screw loosening, pedicle screw breakage, and postoperative back pain because of excessive distraction. In this study, we reported a novel technique for reduction. Additionally, the effect and postoperative radiological parameters of this technique were compared with those of traditional distraction technique. Methods The clinical data of 80 patients who had been treated with posterior pedicle screw fixation from January 2019 to December 2020 was retrospectively analyzed. Thirty‐six patients were performed with the leverage technique, while 22 patients were treated with the traditional distraction technique. When pedicle screw fixation was performed with either the leverage technique or the traditional distraction technique, fracture reduction was completed with monoaxial pedicle screws using either the leverage maneuver or distraction of adjacent vertebrae. Clinical evaluation, including operation time, hospital stay, blood loss volume, and postoperative complications were collected. The American Spinal Injury Association (ASIA) score for neurological condition and the visual analog scale (VAS) score for pain were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t‐test and the χ2‐test (or the Fisher exact test) were used to compare the outcome measures between the two groups. Results The leverage group comprised 36 patients, while 44 patients were included in the distraction group. No statistically significant differences were found in the demographic data. The VAS score in the leverage group (3.0 ± 0.8) was significantly lower than that in the distraction group (4.2 ± 0.6) on postoperative day 1. Total correction of the LKA in the leverage group (11.5 ± 2.5°) was significantly higher than that in the distraction group (7.1 ± 1.3°) (p = 0.0004). Total correction of the RKA was higher in the leverage group (12.1 ± 4.3°) than in the distraction group (6.1 ± 0.9°) (p = 0.005). The ratio of rear pillar /front pillar correction was 0.35 ± 0.13 and 0.89 ± 0.18 in the leverage and distraction groups, respectively (p = 0.014). Total correction of the upper and lower foraminal height in the leverage group was significantly less than that in the distraction group. The leverage group had significantly higher correction of the upper and lower intervertebral space height than the distraction group. Conclusions Our novel leverage technique provided better kyphotic reduction and restoration than compared to conventional distraction technique in the surgical treatment of thoracolumbar compression fractures.

Graphical Abstract

Abstract Purpose To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. Methods This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. Results A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P

Abstract Study design A systematic review and meta-analysis. Background The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement. Methods A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications. Results Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75–3.91, P

A systematic review and meta-analysis was conducted to compare the efficacy and safety of cortical bone trajectory (CBT) screws and traditional pedicle screws in lumbar fusion. Randomized controlled studies and cohort studies on CBT versus pedicle screws in lumbar fusion were searched in China Biology Medicine, China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical and Science Periodicals, PubMed, Cochrane Library, and Web of Science databases. The search period spanned from the establishment of the databases to December 2023. The Cochrane bias risk assessment tool and Newcastle-Ottawa scale were applied to assess the quality of the literature included. Clinical and imaging data as well as surgical outcomes, recovery, and postoperative complications were extracted from the relevant literature. A total of 6 randomized controlled trials and 26 cohort studies were included after screening by inclusion and exclusion criteria with a total of 2478 patients. The meta-analysis demonstrated significant discrepancies between the CBT and TPS groups in Japanese Orthopaedic Association score at 3 and 6 months and final follow-up. Moreover, the TPS group exhibited a higher Oswestry disability index at final follow-up, a greater VAS for low back pain at both 1 week and final follow-up, as well as a higher VAS for leg pain at 1 month. Differences were also noted in surgical and recovery outcomes. However, there was no significant difference between the 2 groups in postoperative complications. CBT and TPS have analogous safety profiles when applied to lumbar fusion, but the clinical efficacy of CBT is superior to that of TPS to some extent, and the procedure is less invasive with faster recovery. [ABSTRACT FROM AUTHOR]

Background: Percutaneous pedicle screw (PPS) placement has become a pivotal technique in spinal surgery, increasing surgical efficiency and limiting the invasiveness of surgical procedures. The aim of this study was to analyze the accuracy of computer-assisted PPS placement with a standardized technique in the lateral decubitus position. Methods: A retrospective review of prospectively collected data was performed on 44 consecutive patients treated between 2021 and 2023 with lateral decubitus single-position surgery. PPS placement was assessed by computed tomography scans, and breaches were graded based on the magnitude and direction of the breach. Facet joint violations were assessed. Variables collected included patient demographics, indication, intraoperative complications, operative time, fluoroscopy time, estimated blood loss, and length of stay. Results: Forty-four patients, with 220 PPSs were identified. About 79.5% of all patients underwent anterior lumbar interbody fusion only, 13.6% underwent lateral lumbar interbody fusion only, and 6.8% received a combination of both anterior lumbar interbody fusion and lateral lumbar interbody fusion. Eleven screw breaches (5%) were identified: 10 were Grade II breaches (<2 mm), and 1 was a Grade IV breach (>4 mm). All breaches were lateral. About 63.6% involved down-side screws indicating a trend toward the laterality of breaches for down-side pedicles. When analyzing breaches by level, 1.2% of screws at L5, 13% at L4, and 11.1% at L3 demonstrated Grade II breaches. No facet joint violations were noted. Conclusion: PPS placement utilizing computer-assisted navigation in lateral decubitus single-position surgery is both safe and accurate. An overall breach rate of 5% was found; considering a safe zone of 2 mm, only 1 screw (0.5%) demonstrated a relevant breach. Clinical Relevance: PPS placement is both safe and accurate. Breaches are rare, and when breaches do occur, they are lateral. [ABSTRACT FROM AUTHOR]

Background: Screw loosening is a commonly reported issue following spinal screw fixation and can lead to various complications. The initial cause of screw loosening is biomechanical deterioration. Previous studies have demonstrated that modifications in screw design can impact the local biomechanical environment, specifically the stress distribution on bone-screw interfaces. There are several different designs of screw tips available for clinically used pedicle screws; however, it remains unclear whether these variations affect the local stress distribution and subsequent screw anchorage ability. Methods: This study conducted comprehensive biomechanical research using polyurethane foam mechanical tests and corresponding numerical simulations to investigate this topic. Models of pedicle screw-fixed osteoporotic polyurethane foam were created with two different clinically used screw tip designs (flat and steep) featuring varying tip lengths, taper angles, and diameters, as well as identical flank overlap areas and thread designs. The anchorage ability of the different models was assessed through toggle and pull-out test. Additionally, numerical mechanical models were utilized to compute the stress distributions at the screw and bone-screw interfaces in the different models. Results: Mechanical tests revealed superior anchorage ability in models utilizing flat-tipped screws. Furthermore, numerical modeling indicated improved anchorage ability and reduced stress concentration tendency in these models. Conclusion: Changes in screw tip design can significantly impact the biomechanical anchoring capability of screws. Specifically, flatter tip pedicle screws may mitigate the risk of screw loosening by alleviating stress concentration on bone-screw interfaces. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the clinical efficacy of injectable cemented hollow pedicle screw (CICPS) in the treatment of osteoporotic lumbar degenerative diseases through a large sample long-term follow-up study. Additionally, we aim to explore the risk factors affecting interbody fusion. Methods: A total of 98 patients who underwent CICPS for transforaminal lumbar interbody fusion (TLIF) for osteoporotic lumbar degenerative disease from March 2011 to September 2017 were analyzed. X-ray and electronic computed tomography (CT) imaging data were collected during preoperative, postoperative, and follow-up periods. The data included changes in intervertebral space height (ΔH), screw failure, cement leakage (CL), and intervertebral fusion. The patients were divided into two groups based on their fusion status one year after surgery: satisfied group A and dissatisfied group B. Surgical data such as operation time, intraoperative bleeding volume and surgical complications were recorded, and visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the improvement of lumbar and leg pain. Results: The mean follow-up time was 101.29 months (ranging from 70 to 128 months). A total of 320 CICPS were used, with 26 screws (8.13%) leaking, 3 screws (0.94%) experiencing cement augmentation failure, and 1 screw (0.31%) becoming loose and breaking. The remaining screws were not loose or pulled out. Female gender, decreased bone density, and CL were identified as risk factors affecting interbody fusion (P < 0.05). Early realization of interbody fusion can effectively prevent the loss of intervertebral space height (P < 0.05) and maintain the surgical treatment effect. Both VAS and ODI scores showed significant improvement during the follow-up period (P < 0.05). Binary logistic regression analysis revealed that decreased bone density and cement leakage were risk factors for prolonged interbody fusion. Conclusions: The results of long-term follow-up indicate that PMMA enhanced CICPS has unique advantages in achieving good clinical efficacy in the treatment of osteoporosis lumbar degenerative diseases. Attention should be paid to identify female gender, severe osteoporosis, and CL as risk factors affecting interbody fusion. [ABSTRACT FROM AUTHOR]

Objective: Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. Methods: Thirty‐two pedicle screws of both types were implanted bilaterally into the L1–4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull‐out tests, as well as cyclic bending and pull‐out tests, while the mechanical properties were assessed using three‐point bending tests. The data generated were statistically analyzed using paired‐sample t‐tests and two independent sample t‐tests. Results: We found that the maximal pull‐out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p < 0.05, p < 0.05). In 800 cycles of the bending tests, neither PSCPS nor HLHPS showed loosening or visible detachment, but their maximal pull‐out forces after cyclic bending tests decreased compared to those in cycles without cyclic bending tests (7.43% and 14.89%, respectively), with no statistical significance (p > 0.05 and p > 0.05, respectively). Additionally, both screws buckled rather than broke in the three‐point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). Conclusions: Compared with the HLHPSs, the PSCPSs have greater pull‐out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation. [ABSTRACT FROM AUTHOR]

Objective: Thoracolumbar compression fractures resulting from high‐energy injuries are a common type of spinal fracture. Satisfying reduction of compressive vertebra body is essential for the clinical outcome. However, traditional distraction technique may lead to complications including pedicle screw loosening, pedicle screw breakage, and postoperative back pain because of excessive distraction. In this study, we reported a novel technique for reduction. Additionally, the effect and postoperative radiological parameters of this technique were compared with those of traditional distraction technique. Methods: The clinical data of 80 patients who had been treated with posterior pedicle screw fixation from January 2019 to December 2020 was retrospectively analyzed. Thirty‐six patients were performed with the leverage technique, while 22 patients were treated with the traditional distraction technique. When pedicle screw fixation was performed with either the leverage technique or the traditional distraction technique, fracture reduction was completed with monoaxial pedicle screws using either the leverage maneuver or distraction of adjacent vertebrae. Clinical evaluation, including operation time, hospital stay, blood loss volume, and postoperative complications were collected. The American Spinal Injury Association (ASIA) score for neurological condition and the visual analog scale (VAS) score for pain were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t‐test and the χ2‐test (or the Fisher exact test) were used to compare the outcome measures between the two groups. Results: The leverage group comprised 36 patients, while 44 patients were included in the distraction group. No statistically significant differences were found in the demographic data. The VAS score in the leverage group (3.0 ± 0.8) was significantly lower than that in the distraction group (4.2 ± 0.6) on postoperative day 1. Total correction of the LKA in the leverage group (11.5 ± 2.5°) was significantly higher than that in the distraction group (7.1 ± 1.3°) (p = 0.0004). Total correction of the RKA was higher in the leverage group (12.1 ± 4.3°) than in the distraction group (6.1 ± 0.9°) (p = 0.005). The ratio of rear pillar /front pillar correction was 0.35 ± 0.13 and 0.89 ± 0.18 in the leverage and distraction groups, respectively (p = 0.014). Total correction of the upper and lower foraminal height in the leverage group was significantly less than that in the distraction group. The leverage group had significantly higher correction of the upper and lower intervertebral space height than the distraction group. Conclusions: Our novel leverage technique provided better kyphotic reduction and restoration than compared to conventional distraction technique in the surgical treatment of thoracolumbar compression fractures. [ABSTRACT FROM AUTHOR]

Pedicle screw and rod systems are widely employed in spine surgeries and loosening due to insufficient mechanical stimulation on the bone is frequently encountered in pedicle screws. This mechanical stimulation problem also arises due to the high rigidity of the implant material. This study aimed to develop new pedicle screws with composite material to solve the pedicle screw loosening problem. The vertebrae and vertebral disk were modeled in three dimension using computerized tomography images obtained from a patient. A commercially available pedicle screw was modeled using Fusion software, and all models were assembled in accordance with the surgical procedure. Pedicle screw models were also divided radially and longitudinally to resemble functionally graded materials, which are composite materials. The load was applied to the top of the T12 vertebra and the screw-vertebral system was fixed to the bottom of the L1 vertebra. The strain results on the vertebrae were examined according to the mechanostat theorem. According to the results, functionally graded material (FGM) pedicle screw decreased the strain on the vertebral bones, and the positive effects on the bone were determined when using the radially functionally graded screws. The maximum stress values were also examined to determine the strengths of all the models. In conclusion, FGM pedicle screw decreased the strain on the bone which is an important parameter for the loosening failure according to the study. The other important conclusion is that FGM pedicle screw can be the solution to the loosening of the screw but not in all vertebrae. [ABSTRACT FROM AUTHOR]

The electrical stimulation of pedicle screws is a technique used to ensure its correct placement within the vertebrae pedicle. Several authors have studied these screws' electrical properties with the objective of understanding if they are a potential source of false negatives. As titanium screws are anodized with different thicknesses of a high electrical resistance oxide (TiO2), this study investigated, using analytical, numerical, and experimental methods, how its thickness may affect pedicle screw's resistance and conductivity. Analytical results have demonstrated that the thickness of the TiO2 layer does result in a significant radial resistance increase (44.21 mΩ/nm, for Ø 4.5 mm), and a decrease of conductivity with layers thicker than 150 nm. The numerical approach denotes that the geometry of the screw further results in a decrease in the pedicle screw conductivity, especially after 125 nm. Additionally, the experimental results demonstrate that there is indeed an effective decrease in conductivity with an increase in the TiO2 layer thickness, which is also reflected in the screw's total resistance. While the magnitude of the resistance associated with each TiO2 layer thickness may not be enough to compromise the ability to use anodized pedicle screws with a high-voltage electrical stimulator, pedicle screws should be the subject of more frequent electrical characterisation studies. [ABSTRACT FROM AUTHOR]

Study Design: Biomechanical cadaveric study. Objectives: Multi-rod constructs maximize posterior fixation, but most use a single pedicle screw (PS) anchor point to support multiple rods. Robotic navigation allows for insertion of PS and cortical screw (CS) within the same pedicle, providing 4 points of bony fixation per vertebra. Recent studies demonstrated radiographic feasibility for dual-screw constructs for posterior lumbar spinal fixation; however, biomechanical characterization of this technique is lacking. Methods: Fourteen cadaveric lumbar specimens (L1–L5) were divided into 2 groups (n = 7): PS, and PS + CS. VCF was simulated at L3. Bilateral posterior screws were placed from L2–L4. Load control (±7.5Nm) testing performed in flexion-extension (FE), lateral bending (LB), axial rotation (AR) to measure ROM of: (1) intact; (2) 2-rod construct; (3) 4-rod construct. Static compression testing of 4-rod construct performed at 5 mm/min to measure failure load, axial stiffness. Results: Four-rod construct was more rigid than 2-rod in FE (P <.001), LB (P <.001), AR (P <.001). Screw technique had no significant effect on FE (P =.516), LB (P =.477), or AR (P =.452). PS + CS 4-rod construct was significantly more stable than PS group (P =.032). Stiffness of PS + CS group (445.8 ± 79.3 N/mm) was significantly greater (P =.019) than PS (317.8 ± 79.8 N/mm). Similarly, failure load of PS + CS group (1824.9 ± 352.2 N) was significantly greater (P =.001) than PS (913.4 ± 309.8 N). Conclusions: Dual-screw, 4-rod construct may be more stable than traditional rod-to-rod connectors, especially in axial rotation. Axial stiffness and ultimate strength of 4-rod, dual-screw construct were significantly greater than rod-to-rod. In this study, 4-rod construct was found to have potential biomechanical benefits of increased strength, stiffness, stability. [ABSTRACT FROM AUTHOR]

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Purpose: To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. Methods: This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. Results: A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P = 0.0005]. Conclusion: Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period. [ABSTRACT FROM AUTHOR]

BACKGROUND: It has been suggested that CT multiplanar reconstruction should be performed prior to the placement of axial pedicle screws to determine the anatomy of the C2 pedicle in each patient, to design the appropriate screw locus and diameter, and to evaluate the feasibility of screw placement to reduce the incidence of surgery-related complications. OBJECTIVE: To evaluate the feasibility of axis pedicle screw placement by morphologic classification of pediculoisthmic component with CT multiplanar reconstruction. METHODS: The CT data of 200 patients (400 axial pedicle screws) with cervical spine were retrospectively studied by using Siemens Syngo.Via software. According to the direction of the axis of the pedicle, the CT multiplanar reconstruction positioning line was adjusted to reconstruct the sectional image of the narrowest part of the pediculoisthmic component. According to its morphological characteristics, the narrowest part of the pediculoisthmic component was divided into three types: type 1, “hook” type: Type 1a outer diameter width (a1)> 0.4 cm, type 1b outer diameter width (a1)≤0.4 cm; type 2, “like circle/ellipse” type; type 3, “horizontal ellipse” type. The outer diameter width of the narrowest part of pediculoisthmic component (d1), medullary cavity width (d2), outer diameter height (a1), and medullary cavity height (a2) were compared among the three types, and the feasibility of pedicle screw placement of the three types was evaluated. RESULTS AND CONCLUSION: (1) A total of 400 axial pedicles included 269 cases of type 1, 130 cases of type 2, and 1 case of type 3. (2) The mean external diameter height between types 1 and 2 was not significantly different (P > 0.05). The mean medullary cavity height, mean outer diameter widths, and mean medullary cavity width were significantly different (P < 0.001). There were 42 cases (15.6%) of type 1 and 0 cases (0.00%) of type 2 with mean external diameter width ≤ 0.4 cm, and the difference was significant (P<0.001). There was only one case of type 3, whose external diameter height, medullary cavity height, outer diameter width and medullary cavity width were 1.20 cm, 0.84 cm, 0.64 cm and 0.31 cm, respectively. (3) These results confirm that axial pedicle screws can be safely inserted in patients with types 1a, 2 and 3, which requires no further measurement and assessment. Pedicle screw insertion should be performed with caution in type 1b patients. Therefore, in type 1 patients, the width of the narrowest outer diameter of the pediculoisthmic component should be further measured to evaluate the feasibility of axial pedicle screw placement. [ABSTRACT FROM AUTHOR]

Study design: A systematic review and meta-analysis. Background: The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement. Methods: A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications. Results: Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75–3.91, P < 0.0001). However, there were no statistically significant differences in achieving "perfect" screw placement between the two groups (OR: 1.52, 95% CI: 0.95–2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25–64.74, P < 0.0001) but shorter postoperative hospital stays (MD: − 1.12, 95% CI: − 2.15 to − 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation. Conclusion: Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss. [ABSTRACT FROM AUTHOR]

Background: Costello syndrome (CS) is a rare genetic syndrome in which, due to the occurrence of a mutation in the HRAS gene on chromosome 11 that causes the manifestation, a set of features such as a characteristic appearance, many congenital defects, intellectual disability and a genetic predisposition to cancer, friendly personality, and others can be identified. CS is very rare, with an incidence of ~1/300,000, but it belongs to one of the largest groups of congenital syndromes, called RASopathies, occurring with an incidence of 1/1000 people. Scoliosis and kyphosis, as well as other spinal defects, are common, in 63% and 58% of patients, respectively, and a study conducted among adult patients showed the presence of scoliosis in 75% of patients; there may be excessive lordosis of the lumbar section and inverted curvatures of the spine (lordosis in the thoracic section and kyphosis in the lumbar section). The aim of our study is to present a case report of treatment of severe scoliosis of 130 degrees in a 14-year-old patient with Costello syndrome, with coexisting Chiari II syndrome and syrinx in the absence of skeletal maturity. This patient underwent foramen magnum decompression 3 months before planned surgical correction for severe scoliosis. The patient was qualified for surgical treatment using magnetically controlled growing rods (MCGR). After spine surgery using MCGR, we gradually performed MCGR distraction over the next 2 years; we performed the final surgery, conversion to posterior spinal fusion (PSF) with simultaneous multi-level Ponte osteotomy, which gave a very good and satisfactory surgical result. In the perioperative period, two serious complications occurred: pneumothorax caused by central catheter and gastrointestinal bleeding due to previously undiagnosed gastrointestinal varices. This case shows that the treatment of severe and neglected scoliosis is complicated and requires special preparation and a surgical plan with other cooperating specialists. The scoliosis was corrected from 130 degrees to approximately 48 degrees, sagittal balance was significantly improved, and the surgical outcome was very pleasing, significantly improving quality of life and function for the patient. [ABSTRACT FROM AUTHOR]

Objective: Spine surgeons are often at risk of radiation exposure due to intraoperative fluoroscopy, leading to health concerns such as carcinogenesis. This is due to the increasing use of percutaneous pedicle screw (PPS) in spinal surgeries, resulting from the widespread adoption of minimally invasive spine stabilization. This study aimed to elucidate the effectiveness of smart glasses (SG) in PPS insertion under fluoroscopy. Methods: SG were used as an alternative screen for fluoroscopic images. Operators A (2-year experience in spine surgery) and B (9-year experience) inserted the PPS into the bilateral L1–5 pedicles of the lumbar model bone under fluoroscopic guidance, repeating this procedure twice with and without SG (groups SG and N-SG, respectively). Each vertebral body's insertion time, radiation dose, and radiation exposure time were measured, and the deviation in screw trajectories was evaluated. Results: The groups SG and N-SG showed no significant difference in insertion time for the overall procedure and each operator. However, group SG had a significantly shorter radiation exposure time than group N-SG for the overall procedure (109.1 ± 43.5 seconds vs. 150.9 ± 38.7 seconds; p = 0.003) and operator A (100.0 ± 29.0 seconds vs. 157.9 ± 42.8 seconds; p = 0.003). The radiation dose was also significantly lower in group SG than in group N-SG for the overall procedure (1.3 ± 0.6 mGy vs. 1.7 ± 0.5 mGy; p = 0.023) and operator A (1.2 ± 0.4 mGy vs. 1.8 ± 0.5 mGy; p = 0.013). The 2 groups showed no significant difference in screw deviation. Conclusion: The application of SG in fluoroscopic imaging for PPS insertion holds potential as a useful method for reducing radiation exposure. [ABSTRACT FROM AUTHOR]

Study Design: Human Cadaveric Biomechanical Study Objectives: Lumbar Lateral Interbody Fusion (LLIF) utilizing a wide cage has been reported as having favorable biomechanical characteristics. We examine the biomechanical stability of unilateral pedicle screw and rod fixation after multilevel LLIF utilizing 26 mm wide cages compared to bilateral fixation. Methods: Eight human cadaveric specimens of L1-L5 were included. Specimens were attached to a universal testing machine (MTS 30/G). Three-dimensional specimen range of motion (ROM) was recorded using an optical motion-tracking device. Specimens were tested in 3 conditions: 1) intact, 2) L1-L5 LLIF (4 levels) with unilateral rod, 3) L1-L5 LLIF with bilateral rods. Results: From the intact condition, LLIF with unilateral rod decreased flexion-extension by 77%, lateral bending by 53%, and axial rotation by 26%. In LLIF with bilateral rods, flexion-extension decreased by 83%, lateral bending by 64%, and axial rotation by 34%. Comparing unilateral and bilateral fixation, LLIF with bilateral rods reduced ROM by a further 23% in flexion-extension, 25% in lateral bending, and 11% in axial rotation. The difference was statistically significant in flexion-extension and lateral bending (P <.005). Conclusions: Considerable decreases in ROM were observed after multilevel (4-level) LLIF utilizing 26 mm cages supplemented with both unilateral and bilateral pedicle screws and rods. The addition of bilateral fixation provides a 10-25% additional decrease in ROM. These results can inform surgeons of the incremental biomechanical benefit when considering unilateral or bilateral posterior fixation after multilevel LLIF. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of robot-assisted full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis. Methods The clinical data of 17 lumbar spondylolisthesis patients underwent robot-assisted Endo-TLIF treatment in Gansu Provincial Hospital from January 2020 to January 2022 were retrospectively collected. The postoperative hospital stay and complications were recorded. The accuracy of pedicle screw placement and the time of single screw placement were calculated. The clinical efficacy was evaluated by modified MacNab and lumbar interbody fusion was evaluated by Suk method. The related scores were recorded before operation, 1 month after operation and at the last follow-up. Results There were (126.45±17.28) min in duration of surgery, (90.00±11.25) mL in intraoperative blood loss, (4.10±0.95) times in intraoperative X-ray fluoroscopy, and (3.54±0.37) days in postoperative hospital stay. The accuracy of pedicle screw placement was 97.06 %, and average pedicle screw placement time was 9.75 min. At the last follow-up, all patients were evaluated to have good lumbar interbody fusion, with the excellent and good rate was 94.12%. One month after operation and at the last follow-up, the visual analogue scale (VAS) score was lower than that before operation, while the total score of Japanese Orthopaedic Association (JOA) was significantly higher than that before operation (P＜0.05). No dura mater injury, nerve tissue injury, screw loosening and fracture were found in all patients. Conclusion Robot-assisted Endo-TLIF in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis has good efficacy, and has the advantages of accurate pedicle screw placement, less trauma, short operation time, and less intraoperative blood loss, but there are problems of high cost and high radiation to patients.

Objective The pedicle screw technique has been widely used in adolescent idiopathic scoliosis orthopedic surgery, but misplacement of screws may damage important structures such as blood vessels and nerves around the pedicle, resulting in serious consequences. Therefore, our research team has independently developed a surgical tool to assist in the placement of pedicle screws. This study aims to investigate the safety and accuracy of postural awareness tool assisted nail placement in orthopedic surgery for adolescent idiopathic scoliosis. Method A retrospective analysis was performed on 24 adolescent patients with idiopathic scoliosis admitted to our hospital from July 2019 to July 2022, including 10 males and 14 females, with an average age of 14.88 ± 2.36 years (10–19 years). The mean follow‐up was 15.67 ± 2.20 months (12–20 months). We divided the patients into postural awareness group (n = 12) and C‐arm group (n = 12) according to whether the postural awareness surgical tool was used during the operation. All patients were treated with posterior spinal orthopedic surgery. The postural awareness group was assisted by pedicle screw placement with a postural awareness surgical tool, while the C‐arm group was given a pedicle screw placement with freehand technique. The operative time, intraoperative blood loss, intraoperative fluoroscopy times, nail placement related complications, nail placement accuracy, and scoliosis correction rate were recorded and compared between the two groups. Results The operative time, intraoperative blood loss and fluoroscopy times in the postural awareness group were significantly lower than those in the C‐arm group, with statistical significance (p