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Background <p>Freehand pedicle screw placement is challenging in adult degenerative scoliosis owing to vertebral rotation and pedicle deformity. We evaluated whether the SPPM+ball-tip workflow was associated with improved intraoperative performance and screw accuracy versus the freehand approach.</p> Methods <p>In this dual-center, retrospective study, 44 adults who underwent posterior thoracolumbar deformity correction (January 2018–January 2024) were assigned to SPPM+ball-tip (<i>n</i> = 22; 320 screws) or freehand (<i>n</i> = 22; 340 screws). The primary outcome was initial pedicle screw placement accuracy on early postoperative CT according to the Gertzbein–Robbins classification. Secondary outcomes included screw insertion time, intraoperative fluoroscopy exposures, blood loss, delayed screw-related mechanical complications, and radiographic correction at 1 week and 1 year.</p> Results <p>The SPPM+ball-tip workflow was associated with higher accuracy than freehand (Grade A 90.6% [290/320] vs. 70.9% [241/340]; clinically acceptable Grades A–B 96.0% [307/320] vs. 87.1% [296/340]; poor C–E 4.0% vs. 12.9%; all <i>P</i> &lt; 0.001). Mean insertion time was shorter (2.45 ± 1.02 vs. 5.12 ± 1.67&#xa0;min/screw; <i>P</i> &lt; 0.001), fluoroscopy exposures fewer (4.1 ± 2.2 vs. 11.1 ± 3.3; <i>P</i> &lt; 0.001), and blood loss lower (280.7 ± 102.3 vs. 450.4 ± 118.7 mL; <i>P</i> &lt; 0.001). Screw cut-out occurred in 0 vs. 5 cases (<i>P</i> = 0.044). Cobb angle correction at 1 week and 1 year was comparable between groups (both <i>P</i> &gt; 0.05).</p> Conclusion <p>The SPPM+ball-tip workflow was associated with higher pedicle screw accuracy and greater operative efficiency, while showing lower radiation exposure and lower intraoperative blood loss, without compromising deformity correction. These findings support the SPPM+ball-tip workflow as a potentially practical alternative to freehand placement. However, because the intervention was evaluated as a combined workflow rather than as isolated components, the independent contribution of SPPM itself cannot be determined from the present study. Prospective multicenter studies are warranted.</p>

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Spatial posture perception method combined with ball-tip technique improves pedicle screw placement in adult degenerative scoliosis: a dual-center retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年5月26日

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  • Xin Xu,
  • Linyang Song,
  • Kun Wang,
  • Fuxin Wang,
  • Zheng Zhang,
  • Ruoxian Song

摘要

Background

Freehand pedicle screw placement is challenging in adult degenerative scoliosis owing to vertebral rotation and pedicle deformity. We evaluated whether the SPPM+ball-tip workflow was associated with improved intraoperative performance and screw accuracy versus the freehand approach.

Methods

In this dual-center, retrospective study, 44 adults who underwent posterior thoracolumbar deformity correction (January 2018–January 2024) were assigned to SPPM+ball-tip (n = 22; 320 screws) or freehand (n = 22; 340 screws). The primary outcome was initial pedicle screw placement accuracy on early postoperative CT according to the Gertzbein–Robbins classification. Secondary outcomes included screw insertion time, intraoperative fluoroscopy exposures, blood loss, delayed screw-related mechanical complications, and radiographic correction at 1 week and 1 year.

Results

The SPPM+ball-tip workflow was associated with higher accuracy than freehand (Grade A 90.6% [290/320] vs. 70.9% [241/340]; clinically acceptable Grades A–B 96.0% [307/320] vs. 87.1% [296/340]; poor C–E 4.0% vs. 12.9%; all P < 0.001). Mean insertion time was shorter (2.45 ± 1.02 vs. 5.12 ± 1.67 min/screw; P < 0.001), fluoroscopy exposures fewer (4.1 ± 2.2 vs. 11.1 ± 3.3; P < 0.001), and blood loss lower (280.7 ± 102.3 vs. 450.4 ± 118.7 mL; P < 0.001). Screw cut-out occurred in 0 vs. 5 cases (P = 0.044). Cobb angle correction at 1 week and 1 year was comparable between groups (both P > 0.05).

Conclusion

The SPPM+ball-tip workflow was associated with higher pedicle screw accuracy and greater operative efficiency, while showing lower radiation exposure and lower intraoperative blood loss, without compromising deformity correction. These findings support the SPPM+ball-tip workflow as a potentially practical alternative to freehand placement. However, because the intervention was evaluated as a combined workflow rather than as isolated components, the independent contribution of SPPM itself cannot be determined from the present study. Prospective multicenter studies are warranted.