Ergin M, Aktaş SA. Enhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization. World J Orthop 2025; 16(12): 112406 [DOI: 10.5312/wjo.v16.i12.112406]
Corresponding Author of This Article
Musa Ergin, Department of Orthopaedics and Traumatology, Cihanbeyli State Hospital, Hastane Cd. No. 61 Cihanbeyli, Konya 42850, Türkiye. drmusaergin@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Dec 17, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Orthopedics
ISSN
2218-5836
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Ergin M, Aktaş SA. Enhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization. World J Orthop 2025; 16(12): 112406 [DOI: 10.5312/wjo.v16.i12.112406]
World J Orthop. Dec 18, 2025; 16(12): 112406 Published online Dec 18, 2025. doi: 10.5312/wjo.v16.i12.112406
Enhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization
Musa Ergin, Süha A Aktaş
Musa Ergin, Department of Orthopaedics and Traumatology, Cihanbeyli State Hospital, Konya 42850, Türkiye
Süha A Aktaş, Department of Orthopedics and Traumatology Clinic, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul 34020, Türkiye
Co-first authors: Musa Ergin and Süha A Aktaş.
Author contributions: Ergin M designed the overall concept and outline of the manuscript; Aktaş SA contributed to the discussion and design of the manuscript; Ergin M and Aktaş SA contributed to the writing, and editing the manuscript, and review of the literature, they contributed equally to this article, they are the co-first authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Musa Ergin, Department of Orthopaedics and Traumatology, Cihanbeyli State Hospital, Hastane Cd. No. 61 Cihanbeyli, Konya 42850, Türkiye. drmusaergin@gmail.com
Received: July 28, 2025 Revised: August 17, 2025 Accepted: October 20, 2025 Published online: December 18, 2025 Processing time: 144 Days and 18 Hours
Abstract
Pedicle 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 Bokov et al contributes significantly to this discussion, identifying predictors of pedicle screw 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.
Core 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 implant failure in complex spinal trauma cases.
