Background <p>Pedicle screws are pivotal in spinal fixation procedures, providing stability and facilitating the correction of spinal deformities. Several designs, including standard, cannulated, fenestrated, and expandable screws, have been developed to optimize fixation strength and address varying patient needs. Standard screws provide reliable fixation, while cannulated screws allow for minimally invasive insertion using a guidewire. </p> Methods <p>Despite their advantages, complications such as screw loosening, misplacement, and breakage remain prevalent. Loosening is often caused by poor bone quality, suboptimal insertion techniques, or excessive mechanical loading. Misplacement can lead to serious neurological and vascular injuries, necessitating precise preoperative planning and intraoperative imaging. Screw breakage, typically due to fatigue failure, underscores the importance of advanced material selection and biomechanical design. Recent technological innovations, such as 3D-printed patient-specific screws, bioactive coatings, and real-time navigation systems, aim to mitigate these complications. Furthermore, artificial intelligence (AI) is emerging as a powerful tool in enhancing surgical precision and predicting screw behavior, improving preoperative planning, and reducing human error during surgery. </p> Conclusion <p>This review examines pedicle screw designs, their biomechanical properties, and the associated complications. It also discusses recent advancements in screw technology and AI-driven tools aimed at improving fixation strength, minimizing complications, and optimizing patient outcomes in spinal fusion procedures.</p>