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The discussion evaluates predictors of pedicle-screw loosening, including low bone radiodensity, longer fixation constructs, and extensive decompression. It outlines adjunctive biomechanically sound strategies—auxiliary posterior fusion, anterior column reconstruction, and intermediate screw usage—while emphasizing preoperative bone-quality assessment via CT Hounsfield unit analysis and MRI-derived vertebral bone quality scoring.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/enhancing-long-term-fixation-in-thoracolumbar-injuries-from-screw-design-to-bone-quality-optimization/406724/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/enhancing-long-term-fixation-in-thoracolumbar-injuries-from-screw-design-to-bone-quality-optimization/406724.png","ImageObject",300,407,{"name":92,"@type":93},"Aldword","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What are the main predictors of pedicle screw loosening in thoracolumbar injuries?","Question",{"text":112,"@type":113},"Low bone radiodensity, longer fixation constructs, and extensive decompression are identified as key predictors of pedicle-screw loosening.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which preoperative assessments are emphasized to improve long-term outcomes?",{"text":117,"@type":113},"Preoperative bone quality assessment is emphasized, including CT-based Hounsfield unit analysis and MRI-derived vertebral bone quality scoring.",{"name":119,"@type":110,"acceptedAnswer":120},"What adjunctive surgical strategies are discussed to support instrumentation stability?",{"text":121,"@type":113},"Adjunctive strategies include auxiliary posterior fusion, anterior column reconstruction, and the use of intermediate screws to support an individualized biomechanically sound plan.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406724,1790956553,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},2336478940917,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| W | J | O | World Journal of\u003Cbr>Orthopedics |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Orthop 2025 December 18; 16(12): 112406  \nDOI: 10.5312/wjo.v16.i12.112406 ISSN 2218-5836 (online)  \nEDITORIAL  \nEnhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization  \nMusa Ergin, Süha A Aktaş  \nSpecialty type: Orthopedics  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade A, Grade B  \nNovelty: Grade A, Grade B  \nCreativity or Innovation: Grade A, Grade B  \nScientific Significance: Grade A, Grade B  \nP-Reviewer: Shi T, MD, Assistant Professor, Associate Chief Physician, China; Sun XY, MD, PhD, Professor, China  \nReceived: July 28, 2025  \nRevised: August 17, 2025  \nAccepted: October 20, 2025  \nPublished online: December 18, 2025  \nProcessing time: 144 Days and 17.9 Hours  \nMusa Ergin, Department of Orthopaedics and Traumatology, Cihanbeyli State Hospital, Konya 42850, Türkiye  \nSüha A Aktaş, Department of Orthopedics and Traumatology Clinic, Istanbul Physical Therapy  \nand Rehabilitation Training and Research Hospital, Istanbul 34020, Türkiye Co-first authors: Musa Ergin and Süha A Aktaş .  \nCorresponding author: Musa Ergin, Department of Orthopaedics and Traumatology, Cihanbeyli State Hospital, Hastane Cd. No. 61 Cihanbeyli, Konya 42850, Türkiye.  \n[drmusaergin@gmail.com](drmusaergin@gmail.com)  \nAbstract  \nPedicle screw fixation remains the gold standard for stabilizing unstable thoracolumbar fractures. However, ensuring long-term instrumentation stability continues to challenge both surgeons and implant designers. The study by Bokovet al contributes significantly to this discussion, identifying predictors of pediclescrew loosening such as low bone radiodensity, longer fixation constructs, and extensive decompression. Adjunctive strategies-auxiliary posterior fusion, anterior column reconstruction, and intermediate screw usage-support an individualized, biomechanically sound surgical plan. In this article, we explore the clinical relevance of these findings within spinal trauma care. We emphasize the role of preoperative bone quality assessment, including computed tomography-based Hounsfield unit analysis and magnetic resonance imaging-derived vertebral bone quality score, as modifiable predictors of long-term outcomes. We also discuss innovations in screw design, surface coatings, and patient-specific planning to reduce failure risk. Furthermore, emerging technologies such as finite element modeling and 3D-printed instrumentation may refine patient-specific strategies. By integrating biomechanical principles with personalized surgical planning, future approaches may enhance fixation durability. Ultimately, aligning mechanical stability with biological sustainability is critical to reducing implant failure in complex thoracolumbar trauma cases.  \nKey Words: Thoracolumbar fractures; Pedicle screw loosening; Bone quality; Finite element modeling; Spinal fixation  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \n WJO  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 18, 2025  Volume 16  Issue 12   \nErgin M et al. Long-term stability in thoracolumbar instrumentation  \nCore Tip: This article highlights key factors influencing long-term pedicle screw stability in thoracolumbar fractures, including bone quality, construct length, and decompression extent. Practical strategies such as computed tomography-based Hounsfield unit and magnetic resonance imaging-based vertebral bone quality score assessment, the use of intermediate screws, and anterior column reconstruction are discussed. Technological advances like coated implants and patient-specific planning are emphasized to enhance long-term outcomes. Integration of these approaches may help reduce impl","cbCaijYSZGtXDIyK","https://ap.wps.com/l/cbCaijYSZGtXDIyK","pdf",399034,"English","# Introduction\n# Bone quality: A critical but modifiable risk factor\n# Core Tip\n# Citation","[{\"question\":\"What are the main predictors of pedicle screw loosening in thoracolumbar injuries?\",\"answer\":\"Low bone radiodensity, longer fixation constructs, and extensive decompression are identified as key predictors of pedicle-screw loosening.\"},{\"question\":\"Which preoperative assessments are emphasized to improve long-term outcomes?\",\"answer\":\"Preoperative bone quality assessment is emphasized, including CT-based Hounsfield unit analysis and MRI-derived vertebral bone quality scoring.\"},{\"question\":\"What adjunctive surgical strategies are discussed to support instrumentation stability?\",\"answer\":\"Adjunctive strategies include auxiliary posterior fusion, anterior column reconstruction, and the use of intermediate screws to support an individualized biomechanically sound plan.\"}]","Enhancing long-term fixation in thoracolumbar injuries - From screw design to bone quality optimization | PDF",1790567546,15]