Enhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization

doi:10.5312/wjo.v16.i12.112406

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Dec 18, 2025 (publication date) through Dec 17, 2025

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Orthop. Dec 18, 2025; 16(12): 112406
Published online Dec 18, 2025. doi: 10.5312/wjo.v16.i12.112406

Table 1 Risk factors and mitigation strategies for screw loosening

Risk factor	Mitigation strategy
Low bone density (HU < 110)	HU/VBQ-based screening, cement augmentation, coated screws
Long posterior construct	Use intermediate screws, consider short-segment fixation
Multilevel decompression	Augment anterior column, limit construct length
Osteoporotic bone	Expandable/fenestrated screws, nanocoated implants, PMMA augmentation
Traumatic disc injury	Assess via MRI, consider anterior support to maintain correction
Fracture at thoracolumbar junction	Biomechanical modeling, optimized trajectory selection

HU: Hounsfield unit; VBQ: Vertebral bone quality; PMMA: Polymethyl methacrylate; MRI: Magnetic resonance imaging.

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Citation: 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
URL: https://www.wjgnet.com/2218-5836/full/v16/i12/112406.htm
DOI: https://dx.doi.org/10.5312/wjo.v16.i12.112406