Application of a Posture-Sensing Method Combined With Blind Guidewire Probing in Percutaneous Pedicle Screw Placement for Single-Level Thoracolumbar Compression Fractures: A Retrospective Comparative Study

Application of a Posture-Sensing Method Combined With Blind Guidewire Probing in Percutaneous Pedicle Screw Placement for Single-Level Thoracolumbar Compression Fractures: A Retrospective Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of a Posture-Sensing Method Combined With Blind Guidewire Probing in Percutaneous Pedicle Screw Placement for Single-Level Thoracolumbar Compression Fractures: A Retrospective Comparative Study Xin Xu, Fuxin Wang, Kun Wang, Ang Li, Junlin Han, Zheng Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8252605/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Mar, 2026 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Percutaneous pedicle screw fixation is widely used for the minimally invasive treatment of single-level thoracolumbar compression fractures. However, the conventional fluoroscopy-guided technique requires repeated imaging, resulting in increased radiation exposure and prolonged operative time. This study aimed to evaluate the clinical efficacy, safety, and efficiency of a posture-sensing method combined with blind guidewire probing for percutaneous pedicle screw placement. Methods This single-center retrospective comparative study included 143 patients with single-level thoracolumbar compression fractures treated between January 2021 and December 2023. Patients were divided into the experimental group (posture-sensing combined with blind guidewire probing, n = 67) and the control group (conventional fluoroscopy-guided technique, n = 76). Perioperative parameters, pedicle screw accuracy based on the Gertzbein–Robbins classification, radiographic outcomes, clinical outcomes (VAS and ODI), and postoperative complications were compared between groups. Results The experimental group showed significantly shorter operation time (48.6 ± 9.2 vs. 89.4 ± 16.5 min), puncture time (7.1 ± 1.5 vs. 24.3 ± 4.8 min), fewer fluoroscopy exposures (5.6 ± 1.4 vs. 15.2 ± 3.8), and less intraoperative blood loss (51.2 ± 22.8 vs. 93.5 ± 36.2 mL) than the control group (all P < 0.001). The perfect screw placement rate (Grade A) was 85.1% in the experimental group and 84.2% in the control group (P = 0.78), and the clinically acceptable rate (Grade A + B) was 96.3% and 96.1%, respectively (P = 0.93). No significant differences were observed in radiographic restoration, VAS, ODI, or their improvement values between groups (all P > 0.05). Overall complication rates were low and comparable between groups. Conclusions The posture-sensing method combined with blind guidewire probing significantly reduces operative time, fluoroscopy exposure, and blood loss while maintaining comparable screw accuracy, radiographic outcomes, and clinical efficacy to the conventional fluoroscopy-guided technique. This method is a safe, efficient, and cost-effective alternative for percutaneous pedicle screw placement, particularly in resource-limited settings. Thoracolumbar compression fracture Percutaneous pedicle screw fixation Posture-sensing technique Blind guidewire probing Minimally invasive spine surgery Radiation exposure Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Thoracolumbar vertebrae represent one of the regions of the spine where mechanical stress is most concentrated, and thoracolumbar compression fractures are common in both high-energy injuries and low-energy falls among the elderly [ 1 ] . If not managed appropriately, patients may develop persistent low back pain, progressive kyphotic deformity, or even delayed neurological dysfunction, severely impairing their quality of life [ 2 ] . Currently, for patients with single-level T8–L5 compression fractures without significant neurological deficits, percutaneous pedicle screw fixation has become an important surgical option due to its advantages of minimal invasiveness, reduced blood loss, reliable fixation, and rapid postoperative recovery [ 3 – 7 ] . The safety and accuracy of percutaneous pedicle screw placement are essential determinants of surgical success. However, the traditional C-arm fluoroscopy-guided method requires repeated anteroposterior and lateral imaging to confirm the puncture trajectory, which not only increases radiation exposure for both surgeons and patients but also raises the risk of screw deviation and cortical breach, particularly in cases with anatomical variations or narrow pedicles [ 8 – 12 ] . Therefore, achieving high screw placement accuracy while reducing fluoroscopy dependence remains a key objective in minimally invasive spinal surgery. In recent years, computer-assisted navigation and robotic-assisted systems have been increasingly used for pedicle screw placement, demonstrating high accuracy and safety in multiple studies [ 13 – 18 ] . Systematic reviews and meta-analyses have shown that robot-assisted techniques outperform conventional freehand placement in terms of Grade A screw proportion and in reducing severe malposition rates [ 13 – 15 ] . Technologies such as O-arm navigation, three-dimensional fluoroscopy, and 3D-printed patient-specific guides have also been proven to enhance screw placement precision and reduce intraoperative adjustments [ 16 – 18 ] . However, these systems are often limited by high equipment costs, substantial maintenance expenses, complex workflows, and steep learning curves, and they require advanced operating room facilities and specialized personnel [ 15 – 18 ] . In China, robotic and navigation technologies are primarily available in large tertiary hospitals, while accessibility remains relatively low in primary and regional medical institutions. Compared with the rapid development of digital and intelligent screw-guidance technology abroad, most primary hospitals in China still rely mainly on traditional fluoroscopy-guided techniques in clinical practice [ 19 – 21 ] . Some researchers have attempted to improve screw placement accuracy by optimizing anatomical landmark identification, modifying puncture strategies, or using simple auxiliary devices such as coplanar guides or improved freehand approaches [ 21 – 24 ] . However, there is still a lack of a mature technique that can systematically reduce fluoroscopy usage, minimize radiation exposure, streamline the screw placement process, and maintain safety, reproducibility, and cost-effectiveness. Against this background, our surgical team has gradually developed a “posture-sensing technique” based on posterior anatomical landmarks through extensive clinical practice in percutaneous pedicle screw fixation. By integrating the surgeon’s three-dimensional understanding of the spatial relationship among the transverse process midline, lateral border of the superior articular process, and pedicle axis, this method allows accurate identification of the entry point and trajectory. We also introduced a “blind guidewire probing technique,” which utilizes the physical properties of the metal guidewire—flexibility, a tendency to follow soft tissue planes, and avoidance of hard cortical structures—to guide the guidewire along a safe cancellous channel through characteristic tactile feedback. Several studies have confirmed that tactile-feedback-based techniques or those assisted by inertial measurement units can significantly improve freehand screw trajectory accuracy without relying on expensive navigation systems [ 19 , 20 ] . A key advantage of this technique is that it requires no additional hardware, does not markedly alter the surgical workflow, and substantially reduces the need for repeated fluoroscopy, making it highly practical for widespread use, particularly in primary hospitals. However, evidence regarding the clinical efficacy, safety, and impact of the combined “posture-sensing technique and blind guidewire probing” on surgical efficiency and fluoroscopy reduction during percutaneous pedicle screw placement for thoracolumbar compression fractures remains limited. Therefore, this retrospective comparative study aims to systematically evaluate differences between this technique and conventional fluoroscopy-guided screw placement in terms of perioperative parameters, screw accuracy, radiographic correction, and clinical outcomes, providing reliable evidence to support safe, efficient, and cost-effective minimally invasive spinal fixation in resource-limited settings. 2. Methods 2.1 Study design and participants This study was a single-center, retrospective comparative analysis. Clinical and radiographic data of patients with single-level thoracolumbar compression fractures who underwent percutaneous pedicle screw fixation in our hospital from January 2021 to December 2023 were retrospectively collected and analyzed. During the study period, a total of 150 patients diagnosed with thoracolumbar compression fractures and treated with percutaneous pedicle screw fixation were screened. According to the screw placement technique applied intraoperatively, patients were divided into two groups: Experimental group: Percutaneous pedicle screw placement using the “posture-sensing method combined with blind guidewire probing” (initial n = 70); Control group: Traditional C-arm fluoroscopy–guided puncture and screw placement (initial n = 80). During follow-up, 3 patients in the experimental group and 4 in the control group were lost. Finally, 143 patients completed at least 12 months of follow-up and were included in the final analysis, with 67 cases in the experimental group and 76 in the control group (see Fig. 1, study flowchart). This study was approved by the institutional ethics committee. As this was a retrospective study, all data were anonymized, and the requirement for written informed consent was waived. 2.2 Inclusion and exclusion criteria Inclusion criteria: Diagnosis of single-level thoracolumbar compression fracture confirmed by imaging (X-ray, CT, or MRI) and clinical findings; injured levels located between T8 and L5, accompanied by significant back pain. AO type A fractures, with no obvious dural sac compression on preoperative imaging and no lower limb neurological deficits. No severe cardiopulmonary dysfunction or other major internal diseases that would contraindicate anesthesia or surgery. Not diagnosed as osteoporotic compression fractures; preoperative CT HU measurements suggested adequate bone quality. Thoracolumbar Injury Classification and Severity Score (TLICS) ≥ 4, meeting surgical indications. Complete clinical, imaging, and follow-up data, with follow-up duration ≥ 12 months. Exclusion criteria: Multilevel thoracolumbar compression fractures or burst fractures requiring canal decompression. Fractures located above T8 or below L5, where percutaneous pedicle screw placement is not suitable due to anatomical or technical reasons. AO type B or C fractures, or cases requiring open decompression due to dural sac compression or neurological deficit. Osteoporotic compression fractures confirmed by clinical and imaging evaluation. TLICS < 4 suitable for conservative treatment. Loss to follow-up or incomplete essential data. 2.3 Collection of baseline data Baseline demographic and injury-related information was recorded, including: Age, sex, BMI, injured level (T8–T10, T11–L1, L2–L5), AO classification (A1, A2, A3), TLICS score, and time from injury to surgery (days).A comparison of baseline characteristics between the two groups is shown in Table 1. No significant differences were observed (P > 0.05). Table 1 Baseline characteristics of patients in the two groups (mean ± SD or n (%)) Variable Experimental group (posture-sensing + blind guidewire, n = 67) Control group (conventional fluoroscopy, n = 76) Statistic (t / χ²) P value Age, years 54.6 ± 11.2 55.2 ± 10.8 0.31 0.76 Male, n (%) 36 (53.7%) 42 (55.3%) 0.03 0.86 BMI, kg/m² 24.6 ± 3.1 24.3 ± 3.0 0.55 0.58 Affected segment, n (%) T8–T10 10 (14.9%) 12 (15.8%) 0.02 0.89 T11–L1 37 (55.2%) 42 (55.3%) < 0.01 0.99 L2–L5 20 (29.9%) 22 (28.9%) 0.02 0.89 AO classification, n (%) A1 18 (26.9%) 21 (27.6%) 0.01 0.94 A2 28 (41.8%) 30 (39.5%) 0.08 0.78 A3 21 (31.3%) 25 (32.9%) 0.04 0.84 TLICS score 4.9 ± 0.8 4.8 ± 0.7 0.79 0.43 Time from injury to surgery, days 3.2 ± 1.4 3.4 ± 1.5 0.8 0.43 Note: BMI, body mass index; TLICS, Thoracolumbar Injury Classification and Severity Score. 2.4 Surgical procedures All patients were placed in the prone position under general anesthesia, with chest and abdomen pads placed to reduce intra-abdominal pressure. C-arm fluoroscopy was used to confirm the fractured level and the target vertebrae for screw placement, followed by surface marking and incision planning. Control group: conventional fluoroscopy-guided puncture and screw placement (1) Surface localization and incision Under anteroposterior and lateral C-arm fluoroscopy, the target vertebra was confirmed, and a 1.5–2.0-cm longitudinal incision was made over the pedicle projection. The entry point for thoracic screws was located at the junction of the outer border of the superior articular process and the upper third of the transverse process; for lumbar screws, the “Magerl’s crest” apex was selected. (2) Puncture and fluoroscopic monitoring The puncture needle was positioned at the planned entry point and slowly advanced toward the pedicle while alternating AP and lateral fluoroscopy: When the lateral view showed the needle tip at the posterior wall of the vertebral body, the AP view should show it within the medial wall of the pedicle. Advancement continued until the lateral image showed the needle reaching the anterior third of the vertebral body, while on AP imaging the tip did not cross the midline (3) Guidewire and screw insertion After satisfactory positioning, the needle core was removed, and a guidewire was inserted. The working cannula was sequentially expanded, followed by tapping and screw insertion under continuous fluoroscopic monitoring. (4) Reduction and fixation After bilateral screw placement, rods were installed and gradually distracted to restore vertebral height and sagittal alignment. Final fluoroscopy confirmed screw position and fracture reduction before wound closure. Experimental group: posture-sensing method combined with blind guidewire probing Surface localization and incision planning were identical to the control group, but fluoroscopy was minimized during puncture and screw placement. (1) Posture-sensing localization of the entry point After initial fluoroscopic confirmation of the level, the surgeon used a puncture needle to gently probe along the transverse process to identify the superior and inferior borders, thereby determining the midpoint. The needle was then slid medially along this midpoint to palpate the lateral border of the superior articular process. The intersection of the “transverse process midline” and “lateral border of the superior articular process” was used as the entry point (Fig. 2). This step integrates preoperative CT understanding of the pedicle axis with real-time anatomical perception, forming a “three-dimensional posture-sensing” of cranial–caudal and medial angulation. (2) “Opening” maneuver and angle control Based on preoperative measurements of pedicle tilt angles, the needle direction was adjusted and advanced approximately 0.5 cm. Penetration through the cortical surface into cancellous bone was identified by a change in tactile resistance from hard to slightly soft. (3) Principle and technique of blind guidewire probing The core concept is that the guidewire is flexible and tends to “follow soft tissue and avoid hard cortex.” After removing the inner needle, the surgeon advanced the guidewire with a brief, controlled force through the established cortical opening. If the guidewire encountered hard cortex, it would deflect rather than penetrate, whereas within cancellous bone it produced a continuous fine “gritty sensation.” A sudden loss of resistance (“empty feeling”) or excessive resistance indicated cortical breach risk, prompting immediate adjustment. A single AP/lateral fluoroscopy was allowed at these key checkpoints (Fig. 3). The tactile feedback characteristics are illustrated in Fig. 4. (4) Tapping and screw insertion After confirming guidewire position, the working cannula was expanded, tapping was performed, and screws were inserted. Unlike the control group, trajectory determination relied primarily on tactile and posture-sensing feedback, with fluoroscopy used sparingly. (5) Reduction and fixation Bilateral screws were connected with rods, distracted for reduction, and final fluoroscopy confirmed satisfactory positioning (Fig. 5).Overall, the posture-sensing method determines the correct entry point and trajectory, while the blind guidewire probing technique advances safely along this trajectory. 2.5 Outcome measures and assessment methods (1) Perioperative parameters Operation time (min): from skin incision to wound closure. Puncture time (min): from skin incision to guidewire entry into cancellous bone confirmed by fluoroscopy. Screw insertion time (min): from guidewire confirmation to completion of all screws. Number of fluoroscopy exposures. Intraoperative blood loss (mL). Total incision length per segment (cm). Postoperative bed rest duration (days). Length of hospital stay (days). (2) Screw placement accuracy Postoperative CT was performed routinely. Two independent spine surgeons evaluated screw positions using the Gertzbein–Robbins classification: Grade A: Completely within the pedicle Grade B: Cortical breach < 2 mm Grade C or above: Cortical breach ≥ 2 mm Perfect accuracy (Grade A) and clinically acceptable accuracy (Grade A+B) were calculated. (3) Radiographic parameters Standing lateral radiographs were obtained preoperatively and at final follow-up: Anterior vertebral height ratio (%) Local Cobb angle (°) Change values were calculated as: Δ height = final – preoperative Δ Cobb = preoperative – final Mean values from two observers were used. (4) Clinical outcomes and complications Pain: VAS (0–10) at pre-op, postoperative day 3, and final follow-up. Function: ODI (%) pre-op and at final follow-up; ΔODI = pre-op – final. Complications: screw cut-out/cortical breach, new/worsened radiculopathy, superficial infection, implant failure, and reoperation. 2.6 Follow-up All patients were followed at 1, 3, 6, and 12 months postoperatively, and annually thereafter. Follow-up included symptoms, physical examination, VAS, ODI, and imaging (X-ray ± CT). The minimum follow-up duration was 12 months, with the longest approximately 36 months. 2.7 Statistical analysis Statistical analysis was performed using SPSS 26.0. Continuous variables were expressed as mean ± standard deviation (x̄±s) and compared using independent-samples t tests. Categorical variables were expressed as counts and percentages and compared using χ² tests or Fisher’s exact test. A P value < 0.05 indicated statistical significance. 3. Results 3.1 Baseline characteristics A total of 143 patients who completed follow-up were finally included, with 67 cases in the experimental group and 76 in the control group. The mean age of patients in the experimental group was 54.6 ± 11.2 years, compared with 55.2 ± 10.8 years in the control group, with no significant difference (t = 0.31, P = 0.76). There were 36 males (53.7%) in the experimental group and 42 males (55.3%) in the control group, with no significant difference (χ² = 0.03, P = 0.86). The BMI was 24.6 ± 3.1 kg/m² in the experimental group and 24.3 ± 3.0 kg/m² in the control group, with no significant difference (t = 0.55, P = 0.58). Regarding the distribution of injured segments, the experimental group included 10 cases (14.9%) at T8–T10, 37 cases (55.2%) at T11–L1, and 20 cases (29.9%) at L2–L5; the control group included 12 cases (15.8%), 42 cases (55.3%), and 22 cases (28.9%), respectively. No significant differences were observed between the two groups (all P > 0.05). With respect to AO classification, there were 18 cases (26.9%) of A1, 28 cases (41.8%) of A2, and 21 cases (31.3%) of A3 in the experimental group, and 21 cases (27.6%), 30 cases (39.5%), and 25 cases (32.9%), respectively, in the control group. No significant differences were observed between the groups (all P > 0.05). The mean TLICS score was 4.9 ± 0.8 in the experimental group and 4.8 ± 0.7 in the control group, showing no significant difference (t = 0.79, P = 0.43). The time from injury to surgery was 3.2 ± 1.4 days and 3.4 ± 1.5 days in the experimental and control groups, respectively, with no significant difference (t = 0.80, P = 0.43). These results indicate that the baseline characteristics were comparable between the two groups (Table 1 ). 3.2 Comparison of perioperative surgical parameters The operation time in the experimental group was 48.6 ± 9.2 min, which was significantly shorter than that in the control group (89.4 ± 16.5 min) (t ≈ 17.6, P < 0.001). The puncture time was 7.1 ± 1.5 min in the experimental group and 24.3 ± 4.8 min in the control group, showing a significant difference (t ≈ 28.5, P < 0.001). The screw placement time was also significantly shorter in the experimental group than in the control group (20.4 ± 4.2 min vs. 29.7 ± 6.5 min, t ≈ 9.8, P < 0.001). The number of intraoperative fluoroscopy exposures was 5.6 ± 1.4 in the experimental group, which was significantly lower than 15.2 ± 3.8 in the control group (t ≈ 19.0, P < 0.001). The intraoperative blood loss was 51.2 ± 22.8 mL in the experimental group and 93.5 ± 36.2 mL in the control group, with a significant difference (t ≈ 8.5, P < 0.001). There was no significant difference in the total incision length per segment between the experimental group (3.1 ± 0.5 cm) and the control group (3.2 ± 0.6 cm) (P = 0.27). The postoperative bed rest time was 1.9 ± 0.6 days and 2.0 ± 0.7 days in the two groups, respectively, with no significant difference (P = 0.37). The length of hospital stay was 7.3 ± 1.8 days in the experimental group and 7.9 ± 2.2 days in the control group, also without a significant difference (P = 0.07) (Table 2 ). Table 2 Comparison of perioperative surgical parameters between the two groups (mean ± SD) Variable Experimental group (n = 67) Control group (n = 76) t value P value Operation time, min 48.6 ± 9.2 89.4 ± 16.5 ≈ 17.6 < 0.001 Puncture time, min 7.1 ± 1.5 24.3 ± 4.8 ≈ 28.5 < 0.001 Screw placement time, min 20.4 ± 4.2 29.7 ± 6.5 ≈ 9.8 < 0.001 Fluoroscopy frequency, times 5.6 ± 1.4 15.2 ± 3.8 ≈ 19.0 < 0.001 Total incision length per segment, cm 3.1 ± 0.5 3.2 ± 0.6 ≈ 1.1 0.27 Intraoperative blood loss, ml 51.2 ± 22.8 93.5 ± 36.2 ≈ 8.5 < 0.001 Postoperative bed rest duration, days 1.9 ± 0.6 2.0 ± 0.7 ≈ 0.9 0.37 Length of hospital stay, days 7.3 ± 1.8 7.9 ± 2.2 ≈ 1.8 0.07 3.3 Comparison of pedicle screw placement accuracy A total of 268 screws were inserted in the experimental group, including 228 Grade A screws (85.1%), 30 Grade B screws (11.2%), and 10 Grade C or higher screws (3.7%). In the control group, 304 screws were inserted, including 256 Grade A screws (84.2%), 36 Grade B screws (11.8%), and 12 Grade C or higher screws (3.9%). There were no significant differences in the distribution of screw grades between the two groups (all P > 0.05). The perfect accuracy rate (Grade A) was 85.10% in the experimental group and 84.20% in the control group (χ² = 0.08, P = 0.78). The clinically acceptable accuracy rate (Grade A + B) was 96.3% in the experimental group and 96.1% in the control group (χ² = 0.01, P = 0.93) (Table 3 ). Table 3 Comparison of pedicle screw placement accuracy between the two groups Variable Experimental group (n = 268 screws) Control group (n = 304 screws) χ² value P value Completely within the pedicle (Grade A) 228 (85.1%) 256 (84.2%) 0.08 0.78 Cortical breach < 2 mm (Grade B) 30 (11.2%) 36 (11.8%) 0.03 0.86 Cortical breach ≥ 2 mm (Grade C or above) 10 (3.7%) 12 (3.9%) 0.01 0.93 Perfect accuracy (Grade A) 85.10% 84.20% 0.08 0.78 Clinically acceptable accuracy (Grade A + B) 258 (96.3%) 292 (96.1%) 0.01 0.93 Note: Perfect accuracy = Grade A; clinically acceptable accuracy = Grade A + B. 3.4 Comparison of radiographic outcomes The preoperative anterior vertebral height ratio was 62.5 ± 8.7% in the experimental group and 63.1 ± 9.1% in the control group, with no significant difference (P = 0.70). At the final follow-up, the values were 91.3 ± 4.5% and 90.7 ± 4.8%, respectively, also with no significant difference (P = 0.44). The restoration value of the anterior vertebral height ratio was 28.8 ± 8.9% in the experimental group and 27.6 ± 9.2% in the control group, with no significant difference (P = 0.46). The preoperative local Cobb angle was 18.6 ± 6.1° in the experimental group and 19.0 ± 6.3° in the control group (P = 0.71). At the final follow-up, the angles were 6.2 ± 3.0° and 6.5 ± 3.2°, respectively (P = 0.58). The Cobb angle correction was 12.4 ± 4.7° in the experimental group and 12.5 ± 4.9° in the control group, with no significant difference (P = 0.91) (Table 4 ). Table 4 Comparison of radiographic parameters between the two groups (mean ± SD) Parameter Time point Experimental group (n = 67) Control group (n = 76) t value P value Anterior vertebral height ratio (%) Preoperative 62.5 ± 8.7 63.1 ± 9.1 0.39 0.7 Final follow-up 91.3 ± 4.5 90.7 ± 4.8 0.77 0.44 Δ (final – preoperative) 28.8 ± 8.9 27.6 ± 9.2 0.74 0.46 Local Cobb angle (°) Preoperative 18.6 ± 6.1 19.0 ± 6.3 0.37 0.71 Final follow-up 6.2 ± 3.0 6.5 ± 3.2 0.55 0.58 Δ (preoperative – final) 12.4 ± 4.7 12.5 ± 4.9 0.12 0.91 Note: Δ values represent changes from baseline. 3.5 Clinical outcomes and complications 3.5.1 Pain and functional outcomes The preoperative VAS score was 7.8 ± 0.8 in the experimental group and 7.7 ± 0.9 in the control group, with no significant difference (t = 0.70, P = 0.49). On postoperative day 3, the VAS score was 3.2 ± 0.9 in the experimental group and 3.5 ± 1.0 in the control group, with no significant difference (t = 1.86, P = 0.065). At the final follow-up, the VAS score was 1.2 ± 0.5 in the experimental group and 1.3 ± 0.6 in the control group, with no significant difference (t = 1.05, P = 0.30). The VAS improvement was 6.6 ± 0.9 and 6.4 ± 1.0 in the experimental and control groups, respectively, with no significant difference (t = 1.26, P = 0.21). The preoperative ODI was 58.0 ± 8.2% in the experimental group and 59.1 ± 9.0% in the control group (t = 0.73, P = 0.47). At the final follow-up, the ODI was 15.3 ± 5.1% and 16.1 ± 5.6% in the two groups, respectively (t = 0.90, P = 0.37). The ODI improvement was 42.7 ± 8.4% in the experimental group and 43.0 ± 8.7% in the control group, with no significant difference (t = 0.20, P = 0.84). 3.5.2 Complications No cases of screw cut-out or obvious cortical breach occurred in the experimental group, whereas 2 cases (2.6%) occurred in the control group, with no significant difference (χ² = 2.01, P = 0.16). One case (1.5%) of transient nerve root irritation was observed in the experimental group and 2 cases (2.6%) in the control group, with no significant difference (χ² = 0.23, P = 0.63). One case of superficial wound infection occurred in each group (1.5% vs. 1.3%), with no significant difference (P = 0.93). No reoperations were performed in the experimental group, whereas 2 cases (2.6%) required reoperation in the control group, with no significant difference (χ² = 2.01, P = 0.16) (Table 5 ). Table 5 Comparison of clinical outcomes and postoperative complications between the two groups Variable Experimental group (n = 67) Control group (n = 76) t / χ² value P value VAS score Preoperative 7.8 ± 0.8 7.7 ± 0.9 0.7 0.49 Postoperative day 3 3.2 ± 0.9 3.5 ± 1.0 1.86 0.065 Final follow-up 1.2 ± 0.5 1.3 ± 0.6 1.05 0.3 ODI (%) Preoperative 58.0 ± 8.2 59.1 ± 9.0 0.73 0.47 Final follow-up 15.3 ± 5.1 16.1 ± 5.6 0.9 0.37 VAS improvement (preoperative – final) 6.6 ± 0.9 6.4 ± 1.0 1.26 0.21 ODI improvement (preoperative – final) 42.7 ± 8.4 43.0 ± 8.7 0.2 0.84 Screw cut-out / significant cortical breach, n (%) 0 (0%) 2 (2.6%) 2.01 0.16* Transient nerve root irritation, n (%) 1 (1.5%) 2 (2.6%) 0.23 0.63 Superficial wound infection, n (%) 1 (1.5%) 1 (1.3%) < 0.01 0.93 Reoperation rate, n (%) 0 (0%) 2 (2.6%) 2.01 0.16* Note: VAS, Visual Analog Scale; ODI, Oswestry Disability Index. *P value from χ² test; values marked with * may be limited by low expected frequencies. 4. Discussion 4.1 Impact of the posture-sensing and blind guidewire probing techniques on operative efficiency and radiation exposure Although percutaneous pedicle screw placement has been widely used in the minimally invasive treatment of thoracolumbar compression fractures, its heavy dependence on C-arm fluoroscopy remains a major limiting factor for further optimization. Gelalis et al. [ 9 ] reported in a systematic review that, during conventional fluoroscopy-guided percutaneous screw placement, each screw typically requires an average of 8–12 fluoroscopic acquisitions, and more than 15 exposures may be needed in complex segments. Laine et al. [ 10 ] , based on dosimetric analysis, found that the annual cumulative radiation dose for spine surgeons performing minimally invasive procedures can approach the upper limit of occupational exposure, posing a potential long-term occupational hazard. In the present study, the number of fluoroscopy exposures in the experimental group was only 5.6 ± 1.4, which was significantly lower than 15.2 ± 3.8 in the control group (P < 0.001). At the same time, puncture time, screw placement time, and total operation time were all markedly reduced in the experimental group. These findings are consistent with the conclusions of Baba et al. [ 19 ] and Kato et al. [ 20 ] , who reported that trajectory guidance based on tactile feedback and spatial orientation can significantly reduce dependence on fluoroscopy. Baba et al. demonstrated in cadaveric experiments that, once a stable tactile–image correlation is established, surgeons can safely perform screw placement with minimal fluoroscopic verification [ 19 ] . The underlying mechanism is as follows: the posture-sensing method reconstructs a tactile “map” from surface to deep structures, integrating the transverse process, superior articular process, and pedicle axis, thereby enabling the surgeon to form a relatively stable three-dimensional spatial model before puncture. The blind guidewire probing technique utilizes the clear difference between the “continuous resistance feedback” in cancellous bone and the “blocking feedback” in front of cortical bone, guiding the guidewire to follow the natural cancellous channel. The combination of these two techniques allows the surgeon to safely advance the guidewire in most cases without relying on repeated fluoroscopy. This shift from an “image-dominant” to a “tactile-dominant with image verification” mode is the key reason for the significant reduction in puncture and screw placement time in the experimental group. From a radiation protection perspective, Motiei-Langroudi et al. [ 11 ] pointed out that the radiation dose received by surgeons during a single percutaneous screw placement procedure is positively correlated with the number of fluoroscopic exposures. In the present study, the ~ 63% reduction in fluoroscopy frequency in the experimental group indicates a substantial decrease in radiation exposure for both patients and surgeons. This has important occupational health implications, particularly in centers where minimally invasive spinal surgery is performed frequently. 4.2 Screw placement accuracy: comparison with conventional fluoroscopy and freehand techniques Screw placement accuracy is always a core indicator for evaluating the safety of any pedicle screw technique. The CT-based grading system proposed by Gertzbein and Robbins [ 8 ] remains the international standard and has been widely used in comparative studies of freehand, fluoroscopy-guided, navigation-assisted, and robot-assisted screw placement. Gelalis et al. [ 9 ] , in a systematic review of 37 clinical studies, reported that the proportion of Grade A screws with freehand and conventional fluoroscopy-assisted techniques typically ranges from 80% to 88%, with clinically acceptable rates exceeding 95%. In the present study, the Grade A rate in the experimental group was 85.1%, and the clinically acceptable rate was 96.3%, which were not significantly different from those in the control group and were highly consistent with the above international data. Motiei-Langroudi et al. [ 11 ] reported a Grade A rate of 83.4% and a Grade B rate of approximately 13% for conventional fluoroscopy-guided pedicle screw placement in the thoracolumbar spine, which is very similar to the results in our control group. These findings indicate that, while reducing dependence on fluoroscopy, the posture-sensing plus blind guidewire probing technique does not compromise screw placement accuracy. From a biomechanical and anatomical perspective, the safety of this technique is based on the fact that the guidewire advances along the path of least resistance within the pedicle cancellous bone, naturally avoiding cortical bone and forming a “self-feedback safety trajectory.” When approaching the medial or lateral wall of the pedicle, resistance increases significantly, prompting the surgeon to immediately withdraw and adjust the direction, thereby avoiding catastrophic breach. The absence of obvious cortical violations in the experimental group further confirms, from a clinical standpoint, the reliability of this tactile-guided “safety channel.” 4.3 Explanation for the lack of between-group differences in radiographic correction and clinical outcomes In this study, there were no significant differences between the two groups in terms of anterior vertebral height restoration, Cobb angle correction, or radiographic parameters at the final follow-up. Similarly, improvements in VAS and ODI scores did not differ significantly between groups. These findings are highly consistent with the results of multiple retrospective studies and meta-analyses conducted by Phan et al. [ 3 ] , Wang et al. [ 4 ] , Han et al. [ 5 ] , and Mittal et al. [ 6 ] . Phan et al. pointed out in their systematic review that in patients with single-level thoracolumbar compression fractures, the long-term radiographic and functional outcomes are only minimally influenced by the type of screw placement assistance used [ 3 ] . From a biomechanical perspective, radiographic correction is determined primarily by the reduction maneuver, stiffness of the screw–rod construct, and restoration of posterior tension band structures, rather than by the specific method used to introduce the guidewire into the pedicle. As long as a symmetric and reliable bilateral fixation pathway is established, it is reasonable that different safe screw placement techniques would yield similar postoperative correction and long-term maintenance. Similarly, improvements in VAS and ODI scores are more closely related to fracture stabilization, early mobilization, and the quality of postoperative rehabilitation than to the screw placement technique per se. Therefore, the present findings indirectly suggest that the core value of the posture-sensing plus blind guidewire probing technique does not lie in “superior clinical efficacy,” but rather in “achieving equivalent efficacy at a lower procedural cost.” 4.4 Comparison and positioning relative to navigation and robot-assisted technologies In recent years, computer navigation and robot-assisted percutaneous pedicle screw systems have been regarded as important advances for improving screw placement accuracy. Multiple meta-analyses by Tarawneh et al. [ 13 ] , Matur et al. [ 14 ] , Peng et al. [ 15 ] , and Tovar et al. [ 16 ] consistently demonstrated that robot-assisted screw placement can achieve Grade A rates exceeding 90%, with significantly lower rates of severe malposition compared with freehand techniques. Sun et al. [ 17 ] and Al-Naseem et al. [ 18 ] further noted that robotic systems may reduce additional trauma related to repeated intraoperative adjustments. However, nearly all of these studies also emphasize the limitations of robotic systems, including high equipment costs, complex preoperative preparation, a strong reliance on accurate image registration, and the need to convert to conventional techniques in cases of system failure or registration error. Moreover, robotic systems do not fundamentally eliminate dependence on fluoroscopy, as multiple imaging checks are still required for intraoperative calibration. In contrast, the posture-sensing plus blind guidewire probing technique used in the present study does not require any additional hardware and relies entirely on the surgeon’s tactile perception and spatial orientation to complete key steps. Although its Grade A rate does not reach the extremely high levels reported for robotic systems, it meets internationally recognized thresholds for clinical safety and offers unique advantages in terms of cost, accessibility, low equipment dependence, and suitability for primary hospitals. Therefore, this technique is better positioned as an “optimal percutaneous screw placement strategy in settings without high-end equipment.” 4.5 Current status of research and implications for promotion in primary hospitals Globally, developed healthcare systems are increasingly focusing on digital upgrading through navigation and robotic technologies [ 13 – 18 ] . In contrast, in many developing countries and resource-limited regions, freehand and fluoroscopy-assisted techniques remain the mainstream approaches for percutaneous pedicle screw placement. In a multicenter study from resource-limited settings, Mittal et al. [ 25 ] pointed out that freehand percutaneous pedicle screw fixation remains the most practical choice due to its low equipment dependence and ease of implementation. In China, numerous studies have focused on “improving screw placement safety in the absence of navigation.” Peng et al. [ 22 ] proposed a localization strategy based on the tangent of the supraspinous ligament; Jetjumnong et al. [ 23 ] introduced a modified Qi technique; and He et al. [ 24 ] optimized freehand placement based on the SAP principle. All of these approaches demonstrated that refined application of anatomical landmarks can maintain high screw placement safety without navigation. The posture-sensing method in the present study represents a further development within this technical framework. Its innovation lies in the first systematic incorporation of tactile feedback into the percutaneous screw placement workflow, and in verifying its safety and efficacy through a clinical comparative study. This feature confers substantial potential for widespread adoption in secondary hospitals and primary spine centers in China, enabling improvement in the overall safety and efficiency of minimally invasive pedicle screw placement without significantly increasing medical costs. 4.6 Learning curve and standardization of the technique The posture-sensing and blind guidewire probing technique is clearly operator-dependent. During the initial learning phase, surgeons still need to rely on repeated fluoroscopy to establish the correlation among tactile perception, imaging findings, and spatial orientation. With increasing experience, tactile feedback gradually becomes the primary source of information, and the number of fluoroscopic exposures decreases significantly. The significantly fewer fluoroscopy shots in the experimental group in this study suggest that, once mastered, this technique can form a stable and efficient operative pattern. Unlike the “device-based learning curve” of robotic systems, this technique involves a “continuous benefit learning curve,” where benefits persist once skills are acquired. A standardized training pathway should include: (1) Systematic training in anatomical and tactile recognition; (2) A stepwise transition from fluoroscopy-dependent to tactile-dominant operation; (3) Strict selection of indications in the early phase (e.g., single-level fractures and segments with relatively large pedicles). 4.7 Complications and safety evaluation In this study, the overall complication rates were low in both groups, with no significant between-group differences. No cases of screw cut-out or reoperation occurred in the experimental group, and only one case of transient nerve root irritation was observed. In contrast, the control group had 2 cases of screw cut-out and 2 cases requiring reoperation. Motiei-Langroudi et al. [ 11 ] and Mittal et al. [ 25 ] reported in large-sample studies that the incidence of screw cut-out after percutaneous pedicle screw fixation is approximately 2%–5%, which is similar to the findings in our control group. The low complication rate in the experimental group suggests that, when indications are strictly observed and the technique is performed by experienced surgeons, the posture-sensing plus blind guidewire probing method does not increase the risk of neurological injury or implant failure. 4.8 Study limitations Despite its clinical relevance, this study has several limitations: (1) The single-center retrospective design inevitably introduces selection bias. (2) The sample size was relatively limited, and the number of certain complications was small. (3) No subgroup analysis was performed based on different surgeons or learning stages. (4) The follow-up period was mainly mid-term, and long-term issues such as implant failure and adjacent segment degeneration could not be fully assessed. (5) Objective radiation dose measurements were not included; fluoroscopy frequency was used only as an indirect indicator. 5. Conclusion In summary, the posture-sensing method combined with blind guidewire probing for percutaneous pedicle screw placement in patients with single-level thoracolumbar compression fractures can significantly shorten operative time, reduce fluoroscopy exposure, and decrease intraoperative blood loss, while maintaining screw placement accuracy, radiographic reduction outcomes, and clinical efficacy comparable to those achieved with conventional fluoroscopy-guided techniques. Compared with navigation- and robot-assisted technologies, this technique shows clear advantages in terms of cost, equipment dependence, and accessibility in primary hospitals. With standardized training and strict selection of indications, this method is expected to serve as a cost-effective percutaneous screw placement strategy and to be applied in a broader range of clinical settings. Abbreviations AO Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation) BMI Body mass index CT Computed tomography HU Hounsfield unit IMU Inertial measurement unit ODI Oswestry Disability Index SAP Superior articular process TLICS Thoracolumbar Injury Classification and Severity Score VAS Visual analogue scale Declarations Ethics approval and consent to participate This retrospective study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments. The study protocol was reviewed and approved by the Ethics Committee of the Affiliated 960th Hospital of the PLA (Approval No. 2025084). Given the retrospective design and the use of anonymized clinical data, the requirement for written informed consent was waived by the Ethics Committee of the Affiliated 960th Hospital of the PLA in accordance with relevant national regulations. Consent for publication Not applicable. This study was a retrospective analysis using anonymized clinical data, and no individual patient-identifiable information is included in this publication. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to institutional regulations regarding patient data confidentiality, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions Xin Xu and Fuxin Wang contributed equally to this study as co-first authors. Xin Xu, Fuxin Wang, and Kun Wang participated in study design, data collection, and statistical analysis, and were major contributors to manuscript drafting. Ang Li and Junlin Han were responsible for clinical data management, imaging measurements, and figure preparation. Ruoxian Song and Zheng Zhang supervised the entire research process, critically revised the manuscript for important intellectual content, and approved the final version for submission. All authors read and approved the final manuscript. Acknowledgements The authors thank the medical and nursing staff of the Department of Spine Surgery, Affiliated 960th Hospital of the PLA, for their support in patient care and data collection. References Zileli M, Sharif S, Fornari M. Incidence and epidemiology of thoracolumbar spine fractures: WFNS Spine Committee recommendations. Neurospine. 2021;18(4):704–12. Wood KB, Li W, Lebl DS, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145–64. Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: a systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85–92. Wang B, Lü G, Patel AA, et al. A retrospective study comparing percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinal injury. Med (Baltim). 2017;96(38):e8104. Han JY, Kim KT, Kim SM, et al. Comparison of percutaneous versus open pedicle screw fixation in thoracolumbar fractures. J Korean Fract Soc. 2020;33(1):1–9. Mittal S, Rana A, Ahuja K, et al. Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoracolumbar burst fractures. Int J Res Orthop. 2021;7(2):286–92. Lu J, Chen YN, Hu MW, et al. Systematic review and meta-analysis of the effect of percutaneous pedicle screw internal fixation for thoracolumbar fractures. Ann Palliat Med. 2022;11(1):xxx–xxx. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990;15(1):11–4. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing freehand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247–55. Laine T, Schlenzka D, Mäkitalo K, et al. Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J. 1997;6(6):402–5. Motiei-Langroudi R, Rahmanian A, Sadeghian H, et al. Assessment of pedicle screw placement accuracy in thoracolumbar spine using conventional methods. J Clin Neurosci. 2015;22(5):879–83. Tarawneh AM, Salem KM, Allam Y, et al. A systematic review and meta-analysis of randomized controlled trials comparing the accuracy of robot-assisted versus conventional freehand pedicle screw placement. Global Spine J. 2021;11(1):22–36. Matur AV, Palmisciano P, Chaurasia B, et al. Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand pedicle screws: a systematic review and meta-analysis. Spine J. 2023;23(4):617–29. Peng YN, Tsai LC, Hsu HC, Kao CH. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med. 2020;8(13):824. Tovar MA, Osorio JA, Makhni MC, et al. Robot-assisted pedicle screw placement versus conventional techniques: a systematic review and meta-analysis of screw accuracy. J Neurosurg Spine. 2022;37(2):299–311. Sun WX, Wang X, Li J, et al. Is robot-assisted pedicle screw placement really superior to conventional techniques? A systematic review and meta-analysis. EFORT Open Rev. 2024;9(11):e24–0062. Al-Naseem AO, Kieser DC, Kandziora F, et al. Robot-assisted pedicle screw placement versus navigation-guided and conventional techniques: a systematic review and meta-analysis. Eur Spine J. 2024;33(5):xxx–xxx. Baba S, Kawaguchi K, Itamoto K, et al. Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy. PLoS ONE. 2020;15(11):e0242512. Kato G, Baba S, Kawaguchi K et al. Inertial measurement unit–assisted implantation of thoracic, lumbar and sacral pedicle screws improves precision of a freehand technique. Spine. (ahead of print). Avila MJ, Baaj AA. Freehand thoracic pedicle screw placement: review of existing strategies and a step-by-step guide using uniform landmarks for all levels. Cureus. 2016;8(2):e501. Peng F, Gao R, Xie Q, et al. Supraspinous ligament arc tangent guided freehand thoracic pedicle screw insertion technique: analysis of screw position and angle between screws and upper endplate. Front Surg. 2023;10:1219816. Jetjumnong C, Norasetthada T. Accuracy and outcomes of freehand thoracic pedicle screw placement using Qi’s technique. J Health Sci Med Res. 2022;40(5):561–9. He J, Zhang H, Jiang Y, et al. SAP principle–guided free hand technique: a secret for accurate and safe thoracic and lumbar pedicle screw insertion. Orthop Surg. 2022;14(5):919–28. Cueva GAJN, Velasco V, Rivas L, et al. Free hand technique for placement of transpedicular screws in thoracolumbar spine: is it safe? Rev Mex Ortop Traum. 2022;36(2):xxx–xxx. Mittal S, Rana A, Ahuja K, et al. Pattern of spine fracture in resource-limited regions and implications for freehand pedicle screw fixation. J Clin Orthop Trauma. 2021;15:27–32. Additional Declarations No competing interests reported. Supplementary Files SupplementaryVideo1.mp4 Supplementary Video 1 Tactile-guided cortical opening, pedicle puncture, and blind guidewire insertion using the posture-sensing technique. The video focuses on the tactile-guided process of cortical opening, puncture, and blind guidewire insertion during percutaneous pedicle screw placement. Cite Share Download PDF Status: Published Journal Publication published 24 Mar, 2026 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 13 Jan, 2026 Reviews received at journal 12 Jan, 2026 Reviewers agreed at journal 11 Jan, 2026 Reviewers agreed at journal 26 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers invited by journal 17 Dec, 2025 Editor assigned by journal 09 Dec, 2025 Submission checks completed at journal 09 Dec, 2025 First submitted to journal 01 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8252605","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":562410979,"identity":"840834d0-42e0-4886-94b9-d4d84feeab95","order_by":0,"name":"Xin Xu","email":"","orcid":"","institution":"Affiliated 960th Hospital of PLA","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Xu","suffix":""},{"id":562410980,"identity":"dfe99c5c-94f2-4629-9e13-3d4856adfb13","order_by":1,"name":"Fuxin Wang","email":"","orcid":"","institution":"Affiliated 960th Hospital of 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1","display":"","copyAsset":false,"role":"figure","size":446409,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy flowchart.\u003c/strong\u003e\u003cbr\u003e\nA total of 150 patients with single-level thoracolumbar compression fractures were screened, met the inclusion criteria, and provided informed consent before randomization. Seventy patients were allocated to the experimental group (posture perception combined with blind guidewire puncture), and 80 were allocated to the control group (traditional fluoroscopy-guided puncture). During follow-up, 3 patients in the experimental group and 4 in the control group were lost to follow-up. Finally, 143 patients completed follow-up and were included in the final analysis (67 in the experimental group and 76 in the control group).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/07477025655c0af75d059cb3.jpeg"},{"id":98763355,"identity":"4273ce03-9527-414a-98d7-710d7744f3aa","added_by":"auto","created_at":"2025-12-22 10:03:50","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":696517,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKey bony landmarks and entry point of the posture perception method.\u003c/strong\u003e\u003cbr\u003e\nPosterior view of a thoracolumbar vertebra. The horizontal blue dashed line represents the midline of the transverse process, and the vertical blue dashed line represents the projection line of the lateral border of the superior articular process. The intersection of these two lines (red circle) defines the recommended percutaneous entry point for the posture perception method.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/7407c11b05718fb9129c84ec.jpeg"},{"id":98780846,"identity":"f2f38517-f103-4e37-af69-e255af26f5a0","added_by":"auto","created_at":"2025-12-22 12:31:44","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":744298,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIntraoperative anteroposterior and lateral fluoroscopic views of the blind guidewire trajectory.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA: Anteroposterior C-arm fluoroscopy showing the guidewire centered within the pedicle shadow of the target vertebra, without crossing the medial or lateral cortical margins, indicating that the blind guidewire remains within the cancellous safe corridor of the pedicle.\u003cbr\u003e\nB: Lateral fluoroscopy demonstrating the guidewire entering the pedicle from the posture perception–defined entry point and advancing along the pedicle axis into the anterior one-third of the vertebral cancellous body, without breaching the anterior or posterior vertebral cortex; only a single AP and lateral shot is used at this key checkpoint to verify guidewire position.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/35c960495b5f6758f8e3965f.jpeg"},{"id":98780153,"identity":"ac2f475a-dac4-4afc-ad7e-2e0cdf64a8d0","added_by":"auto","created_at":"2025-12-22 12:31:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":251763,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAxial schematic illustrating guidewire trajectories and the mechanism of the “gravel sensation”.\u003c/strong\u003e\u003cbr\u003e\nThe blue curve represents the ideal guidewire trajectory passing through the pedicle into the cancellous portion of the vertebral body. Along the intraosseous segment, repeated contact between the guidewire and trabecular bone produces subtle, continuous changes in resistance that are perceived by the surgeon as a characteristic “gravel sensation” (①), indicating that the guidewire remains within the cancellous safe corridor of the pedicle and vertebral body. The red and black curves depict trajectories deviating medially and laterally, respectively, with the green circles marking the points where the guidewire first touches the inner or outer cortical wall of the pedicle (②, ③). Because of its elasticity, the guidewire is blocked by the dense cortex and tends to bend back toward the path of least resistance, re-entering the cancellous bone. This “soft-preference” behaviour helps to avoid unintended cortical breach and potential violation of the spinal canal.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/57ae3b01f7deed6ba37c420e.png"},{"id":98763357,"identity":"642ff53f-cf8b-469f-b00f-9621475717f5","added_by":"auto","created_at":"2025-12-22 10:03:50","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":757248,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIntraoperative anteroposterior and lateral fluoroscopic views of the final percutaneous pedicle screw–rod construct.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA: Anteroposterior C-arm fluoroscopy showing symmetric placement of bilateral pedicle screws and connecting rods within the pedicle shadows without evident medial or lateral malposition.\u003cbr\u003e\nB: Lateral view demonstrating pedicle screws advancing along the pedicle axis into the vertebral body with restoration of vertebral height and sagittal alignment after rod distraction, without breaching the anterior or posterior vertebral cortex.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/fbbca2bea775aa42216f1602.jpeg"},{"id":98763367,"identity":"dcefcc40-0a60-4248-8b13-4f96dab409f0","added_by":"auto","created_at":"2025-12-22 10:03:51","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1052129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRepresentative case showing pre- and postoperative radiographs.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA, B: Preoperative anteroposterior (A) and lateral (B) radiographs of the thoracolumbar spine demonstrating a single-level compression fracture with loss of anterior vertebral height and local kyphotic deformity.\u003cbr\u003e\nC, D: Immediate postoperative anteroposterior (C) and lateral (D) radiographs after percutaneous pedicle screw fixation showing restoration of vertebral height and correction of kyphosis, with satisfactory position of the pedicle screws and rod construct and no obvious screw malposition or implant failure.\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/b87974624fed8cb002a83354.jpeg"},{"id":105756042,"identity":"f730bf16-4d02-4936-89fa-f73d8a742b5e","added_by":"auto","created_at":"2026-03-30 16:34:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5736382,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/d4c296e5-4d4c-4eea-af04-39bcf6d2d563.pdf"},{"id":98763373,"identity":"a106dcd6-d507-48c8-b06d-aa60624e670b","added_by":"auto","created_at":"2025-12-22 10:03:56","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":147889448,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary Video 1\u003c/p\u003e\n\u003cp\u003eTactile-guided cortical opening, pedicle puncture, and blind guidewire insertion using the posture-sensing technique.\u003cbr\u003e\nThe video focuses on the tactile-guided process of cortical opening, puncture, and blind guidewire insertion during percutaneous pedicle screw placement.\u003c/p\u003e","description":"","filename":"SupplementaryVideo1.mp4","url":"https://assets-eu.researchsquare.com/files/rs-8252605/v1/35dcf7a3f5c3679d28c92eaa.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of a Posture-Sensing Method Combined With Blind Guidewire Probing in Percutaneous Pedicle Screw Placement for Single-Level Thoracolumbar Compression Fractures: A Retrospective Comparative Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThoracolumbar vertebrae represent one of the regions of the spine where mechanical stress is most concentrated, and thoracolumbar compression fractures are common in both high-energy injuries and low-energy falls among the elderly \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. If not managed appropriately, patients may develop persistent low back pain, progressive kyphotic deformity, or even delayed neurological dysfunction, severely impairing their quality of life \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Currently, for patients with single-level T8\u0026ndash;L5 compression fractures without significant neurological deficits, percutaneous pedicle screw fixation has become an important surgical option due to its advantages of minimal invasiveness, reduced blood loss, reliable fixation, and rapid postoperative recovery \u003csup\u003e[\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe safety and accuracy of percutaneous pedicle screw placement are essential determinants of surgical success. However, the traditional C-arm fluoroscopy-guided method requires repeated anteroposterior and lateral imaging to confirm the puncture trajectory, which not only increases radiation exposure for both surgeons and patients but also raises the risk of screw deviation and cortical breach, particularly in cases with anatomical variations or narrow pedicles \u003csup\u003e[\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Therefore, achieving high screw placement accuracy while reducing fluoroscopy dependence remains a key objective in minimally invasive spinal surgery.\u003c/p\u003e \u003cp\u003eIn recent years, computer-assisted navigation and robotic-assisted systems have been increasingly used for pedicle screw placement, demonstrating high accuracy and safety in multiple studies \u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Systematic reviews and meta-analyses have shown that robot-assisted techniques outperform conventional freehand placement in terms of Grade A screw proportion and in reducing severe malposition rates \u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTechnologies such as O-arm navigation, three-dimensional fluoroscopy, and 3D-printed patient-specific guides have also been proven to enhance screw placement precision and reduce intraoperative adjustments \u003csup\u003e[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. However, these systems are often limited by high equipment costs, substantial maintenance expenses, complex workflows, and steep learning curves, and they require advanced operating room facilities and specialized personnel \u003csup\u003e[\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. In China, robotic and navigation technologies are primarily available in large tertiary hospitals, while accessibility remains relatively low in primary and regional medical institutions.\u003c/p\u003e \u003cp\u003eCompared with the rapid development of digital and intelligent screw-guidance technology abroad, most primary hospitals in China still rely mainly on traditional fluoroscopy-guided techniques in clinical practice \u003csup\u003e[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Some researchers have attempted to improve screw placement accuracy by optimizing anatomical landmark identification, modifying puncture strategies, or using simple auxiliary devices such as coplanar guides or improved freehand approaches \u003csup\u003e[\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. However, there is still a lack of a mature technique that can systematically reduce fluoroscopy usage, minimize radiation exposure, streamline the screw placement process, and maintain safety, reproducibility, and cost-effectiveness.\u003c/p\u003e \u003cp\u003eAgainst this background, our surgical team has gradually developed a \u0026ldquo;posture-sensing technique\u0026rdquo; based on posterior anatomical landmarks through extensive clinical practice in percutaneous pedicle screw fixation. By integrating the surgeon\u0026rsquo;s three-dimensional understanding of the spatial relationship among the transverse process midline, lateral border of the superior articular process, and pedicle axis, this method allows accurate identification of the entry point and trajectory. We also introduced a \u0026ldquo;blind guidewire probing technique,\u0026rdquo; which utilizes the physical properties of the metal guidewire\u0026mdash;flexibility, a tendency to follow soft tissue planes, and avoidance of hard cortical structures\u0026mdash;to guide the guidewire along a safe cancellous channel through characteristic tactile feedback. Several studies have confirmed that tactile-feedback-based techniques or those assisted by inertial measurement units can significantly improve freehand screw trajectory accuracy without relying on expensive navigation systems \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. A key advantage of this technique is that it requires no additional hardware, does not markedly alter the surgical workflow, and substantially reduces the need for repeated fluoroscopy, making it highly practical for widespread use, particularly in primary hospitals.\u003c/p\u003e \u003cp\u003eHowever, evidence regarding the clinical efficacy, safety, and impact of the combined \u0026ldquo;posture-sensing technique and blind guidewire probing\u0026rdquo; on surgical efficiency and fluoroscopy reduction during percutaneous pedicle screw placement for thoracolumbar compression fractures remains limited. Therefore, this retrospective comparative study aims to systematically evaluate differences between this technique and conventional fluoroscopy-guided screw placement in terms of perioperative parameters, screw accuracy, radiographic correction, and clinical outcomes, providing reliable evidence to support safe, efficient, and cost-effective minimally invasive spinal fixation in resource-limited settings.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e2.1 Study design and participants\u003c/p\u003e\n\u003cp\u003eThis study was a single-center, retrospective comparative analysis. Clinical and radiographic data of patients with single-level thoracolumbar compression fractures who underwent percutaneous pedicle screw fixation in our hospital from January 2021 to December 2023 were retrospectively collected and analyzed.\u003c/p\u003e\n\u003cp\u003eDuring the study period, a total of 150 patients diagnosed with thoracolumbar compression fractures and treated with percutaneous pedicle screw fixation were screened. According to the screw placement technique applied intraoperatively, patients were divided into two groups:\u003c/p\u003e\n\u003cp\u003eExperimental group: Percutaneous pedicle screw placement using the \u0026ldquo;posture-sensing method combined with blind guidewire probing\u0026rdquo; (initial n = 70);\u003c/p\u003e\n\u003cp\u003eControl group: Traditional C-arm fluoroscopy\u0026ndash;guided puncture and screw placement (initial n = 80).\u003c/p\u003e\n\u003cp\u003eDuring follow-up, 3 patients in the experimental group and 4 in the control group were lost. Finally, 143 patients completed at least 12 months of follow-up and were included in the final analysis, with 67 cases in the experimental group and 76 in the control group (see Fig. 1, study flowchart).\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional ethics committee. As this was a retrospective study, all data were anonymized, and the requirement for written informed consent was waived.\u003c/p\u003e\n\u003cp\u003e2.2 Inclusion and exclusion criteria\u003c/p\u003e\n\u003cp\u003eInclusion criteria:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDiagnosis of single-level thoracolumbar compression fracture confirmed by imaging (X-ray, CT, or MRI) and clinical findings; injured levels located between T8 and L5, accompanied by significant back pain.\u003c/li\u003e\n \u003cli\u003eAO type A fractures, with no obvious dural sac compression on preoperative imaging and no lower limb neurological deficits.\u003c/li\u003e\n \u003cli\u003eNo severe cardiopulmonary dysfunction or other major internal diseases that would contraindicate anesthesia or surgery.\u003c/li\u003e\n \u003cli\u003eNot diagnosed as osteoporotic compression fractures; preoperative CT HU measurements suggested adequate bone quality.\u003c/li\u003e\n \u003cli\u003eThoracolumbar Injury Classification and Severity Score (TLICS) \u0026ge; 4, meeting surgical indications.\u003c/li\u003e\n \u003cli\u003eComplete clinical, imaging, and follow-up data, with follow-up duration \u0026ge; 12 months.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eExclusion criteria:\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eMultilevel thoracolumbar compression fractures or burst fractures requiring canal decompression.\u003c/li\u003e\n \u003cli\u003eFractures located above T8 or below L5, where percutaneous pedicle screw placement is not suitable due to anatomical or technical reasons.\u003c/li\u003e\n \u003cli\u003eAO type B or C fractures, or cases requiring open decompression due to dural sac compression or neurological deficit.\u003c/li\u003e\n \u003cli\u003eOsteoporotic compression fractures confirmed by clinical and imaging evaluation.\u003c/li\u003e\n \u003cli\u003eTLICS \u0026lt; 4 suitable for conservative treatment.\u003c/li\u003e\n \u003cli\u003eLoss to follow-up or incomplete essential data.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e2.3 Collection of baseline data\u003c/p\u003e\n\u003cp\u003eBaseline demographic and injury-related information was recorded, including:\u003c/p\u003e\n\u003cp\u003eAge, sex, BMI, injured level (T8\u0026ndash;T10, T11\u0026ndash;L1, L2\u0026ndash;L5), AO classification (A1, A2, A3), TLICS score, and time from injury to surgery (days).A comparison of baseline characteristics between the two groups is shown in Table 1. No significant differences were observed (P \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients in the two groups (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%))\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental group (posture-sensing\u0026thinsp;+\u0026thinsp;blind guidewire, n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (conventional fluoroscopy, n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic (t / χ\u0026sup2;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI, kg/m\u0026sup2;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAffected segment, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT8\u0026ndash;T10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT11\u0026ndash;L1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u0026ndash;L5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAO classification, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTLICS score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime from injury to surgery, days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: BMI, body mass index; TLICS, Thoracolumbar Injury Classification and Severity Score.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e2.4 Surgical procedures\u003c/p\u003e\n\u003cp\u003eAll patients were placed in the prone position under general anesthesia, with chest and abdomen pads placed to reduce intra-abdominal pressure. C-arm fluoroscopy was used to confirm the fractured level and the target vertebrae for screw placement, followed by surface marking and incision planning.\u003c/p\u003e\n\u003cp\u003eControl group: conventional fluoroscopy-guided puncture and screw placement\u003c/p\u003e\n\u003cp\u003e(1) Surface localization and incision\u003c/p\u003e\n\u003cp\u003eUnder anteroposterior and lateral C-arm fluoroscopy, the target vertebra was confirmed, and a 1.5\u0026ndash;2.0-cm longitudinal incision was made over the pedicle projection. The entry point for thoracic screws was located at the junction of the outer border of the superior articular process and the upper third of the transverse process; for lumbar screws, the \u0026ldquo;Magerl\u0026rsquo;s crest\u0026rdquo; apex was selected.\u003c/p\u003e\n\u003cp\u003e(2) Puncture and fluoroscopic monitoring\u003c/p\u003e\n\u003cp\u003eThe puncture needle was positioned at the planned entry point and slowly advanced toward the pedicle while alternating AP and lateral fluoroscopy: When the lateral view showed the needle tip at the posterior wall of the vertebral body, the AP view should show it within the medial wall of the pedicle. Advancement continued until the lateral image showed the needle reaching the anterior third of the vertebral body, while on AP imaging the tip did not cross the midline\u003c/p\u003e\n\u003cp\u003e(3) Guidewire and screw insertion\u003c/p\u003e\n\u003cp\u003eAfter satisfactory positioning, the needle core was removed, and a guidewire was inserted. The working cannula was sequentially expanded, followed by tapping and screw insertion under continuous fluoroscopic monitoring.\u003c/p\u003e\n\u003cp\u003e(4) Reduction and fixation\u003c/p\u003e\n\u003cp\u003eAfter bilateral screw placement, rods were installed and gradually distracted to restore vertebral height and sagittal alignment. Final fluoroscopy confirmed screw position and fracture reduction before wound closure.\u003c/p\u003e\n\u003cp\u003eExperimental group: posture-sensing method combined with blind guidewire probing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurface localization and incision planning were identical to the control group, but fluoroscopy was minimized during puncture and screw placement.\u003c/p\u003e\n\u003cp\u003e(1) Posture-sensing localization of the entry point\u003c/p\u003e\n\u003cp\u003eAfter initial fluoroscopic confirmation of the level, the surgeon used a puncture needle to gently probe along the transverse process to identify the superior and inferior borders, thereby determining the midpoint. The needle was then slid medially along this midpoint to palpate the lateral border of the superior articular process. The intersection of the \u0026ldquo;transverse process midline\u0026rdquo; and \u0026ldquo;lateral border of the superior articular process\u0026rdquo; was used as the entry point (Fig. 2). This step integrates preoperative CT understanding of the pedicle axis with real-time anatomical perception, forming a \u0026ldquo;three-dimensional posture-sensing\u0026rdquo; of cranial\u0026ndash;caudal and medial angulation.\u003c/p\u003e\n\u003cp\u003e(2) \u0026ldquo;Opening\u0026rdquo; maneuver and angle control\u003c/p\u003e\n\u003cp\u003eBased on preoperative measurements of pedicle tilt angles, the needle direction was adjusted and advanced approximately 0.5 cm. Penetration through the cortical surface into cancellous bone was identified by a change in tactile resistance from hard to slightly soft.\u003c/p\u003e\n\u003cp\u003e(3) Principle and technique of blind guidewire probing\u003c/p\u003e\n\u003cp\u003eThe core concept is that the guidewire is flexible and tends to \u0026ldquo;follow soft tissue and avoid hard cortex.\u0026rdquo; After removing the inner needle, the surgeon advanced the guidewire with a brief, controlled force through the established cortical opening. If the guidewire encountered hard cortex, it would deflect rather than penetrate, whereas within cancellous bone it produced a continuous fine \u0026ldquo;gritty sensation.\u0026rdquo; A sudden loss of resistance (\u0026ldquo;empty feeling\u0026rdquo;) or excessive resistance indicated cortical breach risk, prompting immediate adjustment. A single AP/lateral fluoroscopy was allowed at these key checkpoints (Fig. 3). The tactile feedback characteristics are illustrated in Fig. 4.\u003c/p\u003e\n\u003cp\u003e(4) Tapping and screw insertion\u003c/p\u003e\n\u003cp\u003eAfter confirming guidewire position, the working cannula was expanded, tapping was performed, and screws were inserted. Unlike the control group, trajectory determination relied primarily on tactile and posture-sensing feedback, with fluoroscopy used sparingly.\u003c/p\u003e\n\u003cp\u003e(5) Reduction and fixation\u003c/p\u003e\n\u003cp\u003eBilateral screws were connected with rods, distracted for reduction, and final fluoroscopy confirmed satisfactory positioning (Fig. 5).Overall, the posture-sensing method determines the correct entry point and trajectory, while the blind guidewire probing technique advances safely along this trajectory.\u003c/p\u003e\n\u003cp\u003e2.5 Outcome measures and assessment methods\u003c/p\u003e\n\u003cp\u003e(1) Perioperative parameters\u003c/p\u003e\n\u003cp\u003eOperation time (min): from skin incision to wound closure.\u003c/p\u003e\n\u003cp\u003ePuncture time (min): from skin incision to guidewire entry into cancellous bone confirmed by fluoroscopy.\u003c/p\u003e\n\u003cp\u003eScrew insertion time (min): from guidewire confirmation to completion of all screws.\u003c/p\u003e\n\u003cp\u003eNumber of fluoroscopy exposures.\u003c/p\u003e\n\u003cp\u003eIntraoperative blood loss (mL).\u003c/p\u003e\n\u003cp\u003eTotal incision length per segment (cm).\u003c/p\u003e\n\u003cp\u003ePostoperative bed rest duration (days).\u003c/p\u003e\n\u003cp\u003eLength of hospital stay (days).\u003c/p\u003e\n\u003cp\u003e(2) Screw placement accuracy\u003c/p\u003e\n\u003cp\u003ePostoperative CT was performed routinely. Two independent spine surgeons evaluated screw positions using the Gertzbein\u0026ndash;Robbins classification:\u003c/p\u003e\n\u003cp\u003eGrade A: Completely within the pedicle\u003c/p\u003e\n\u003cp\u003eGrade B: Cortical breach \u0026lt; 2 mm\u003c/p\u003e\n\u003cp\u003eGrade C or above: Cortical breach \u0026ge; 2 mm\u003cbr\u003e\u0026nbsp;Perfect accuracy (Grade A) and clinically acceptable accuracy (Grade A+B) were calculated.\u003c/p\u003e\n\u003cp\u003e(3) Radiographic parameters\u003c/p\u003e\n\u003cp\u003eStanding lateral radiographs were obtained preoperatively and at final follow-up:\u003c/p\u003e\n\u003cp\u003eAnterior vertebral height ratio (%)\u003c/p\u003e\n\u003cp\u003eLocal Cobb angle (\u0026deg;)\u003cbr\u003e\u0026nbsp;Change values were calculated as:\u003c/p\u003e\n\u003cp\u003e\u0026Delta; height = final \u0026ndash; preoperative\u003c/p\u003e\n\u003cp\u003e\u0026Delta; Cobb = preoperative \u0026ndash; final\u003cbr\u003e\u0026nbsp;Mean values from two observers were used.\u003c/p\u003e\n\u003cp\u003e(4) Clinical outcomes and complications\u003c/p\u003e\n\u003cp\u003ePain: VAS (0\u0026ndash;10) at pre-op, postoperative day 3, and final follow-up.\u003c/p\u003e\n\u003cp\u003eFunction: ODI (%) pre-op and at final follow-up; \u0026Delta;ODI = pre-op \u0026ndash; final.\u003c/p\u003e\n\u003cp\u003eComplications: screw cut-out/cortical breach, new/worsened radiculopathy, superficial infection, implant failure, and reoperation.\u003c/p\u003e\n\u003cp\u003e2.6 Follow-up\u003c/p\u003e\n\u003cp\u003eAll patients were followed at 1, 3, 6, and 12 months postoperatively, and annually thereafter. Follow-up included symptoms, physical examination, VAS, ODI, and imaging (X-ray \u0026plusmn; CT). The minimum follow-up duration was 12 months, with the longest approximately 36 months.\u003c/p\u003e\n\u003cp\u003e2.7 Statistical analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 26.0. Continuous variables were expressed as mean \u0026plusmn; standard deviation (x̄\u0026plusmn;s) and compared using independent-samples t tests. Categorical variables were expressed as counts and percentages and compared using \u0026chi;\u0026sup2; tests or Fisher\u0026rsquo;s exact test. A P value \u0026lt; 0.05 indicated statistical significance.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e \u003cp\u003eA total of 143 patients who completed follow-up were finally included, with 67 cases in the experimental group and 76 in the control group.\u003c/p\u003e \u003cp\u003eThe mean age of patients in the experimental group was 54.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2 years, compared with 55.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;0.31, P\u0026thinsp;=\u0026thinsp;0.76). There were 36 males (53.7%) in the experimental group and 42 males (55.3%) in the control group, with no significant difference (χ\u0026sup2; = 0.03, P\u0026thinsp;=\u0026thinsp;0.86). The BMI was 24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 kg/m\u0026sup2; in the experimental group and 24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 kg/m\u0026sup2; in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;0.55, P\u0026thinsp;=\u0026thinsp;0.58).\u003c/p\u003e \u003cp\u003eRegarding the distribution of injured segments, the experimental group included 10 cases (14.9%) at T8\u0026ndash;T10, 37 cases (55.2%) at T11\u0026ndash;L1, and 20 cases (29.9%) at L2\u0026ndash;L5; the control group included 12 cases (15.8%), 42 cases (55.3%), and 22 cases (28.9%), respectively. No significant differences were observed between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eWith respect to AO classification, there were 18 cases (26.9%) of A1, 28 cases (41.8%) of A2, and 21 cases (31.3%) of A3 in the experimental group, and 21 cases (27.6%), 30 cases (39.5%), and 25 cases (32.9%), respectively, in the control group. No significant differences were observed between the groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe mean TLICS score was 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 in the experimental group and 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 in the control group, showing no significant difference (t\u0026thinsp;=\u0026thinsp;0.79, P\u0026thinsp;=\u0026thinsp;0.43). The time from injury to surgery was 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 days and 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 days in the experimental and control groups, respectively, with no significant difference (t\u0026thinsp;=\u0026thinsp;0.80, P\u0026thinsp;=\u0026thinsp;0.43).\u003c/p\u003e \u003cp\u003eThese results indicate that the baseline characteristics were comparable between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of perioperative surgical parameters\u003c/h2\u003e \u003cp\u003eThe operation time in the experimental group was 48.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 min, which was significantly shorter than that in the control group (89.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5 min) (t\u0026thinsp;\u0026asymp;\u0026thinsp;17.6, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The puncture time was 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 min in the experimental group and 24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 min in the control group, showing a significant difference (t\u0026thinsp;\u0026asymp;\u0026thinsp;28.5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The screw placement time was also significantly shorter in the experimental group than in the control group (20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 min vs. 29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5 min, t\u0026thinsp;\u0026asymp;\u0026thinsp;9.8, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe number of intraoperative fluoroscopy exposures was 5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 in the experimental group, which was significantly lower than 15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 in the control group (t\u0026thinsp;\u0026asymp;\u0026thinsp;19.0, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The intraoperative blood loss was 51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8 mL in the experimental group and 93.5\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2 mL in the control group, with a significant difference (t\u0026thinsp;\u0026asymp;\u0026thinsp;8.5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThere was no significant difference in the total incision length per segment between the experimental group (3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 cm) and the control group (3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 cm) (P\u0026thinsp;=\u0026thinsp;0.27). The postoperative bed rest time was 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 days and 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 days in the two groups, respectively, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.37). The length of hospital stay was 7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 days in the experimental group and 7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 days in the control group, also without a significant difference (P\u0026thinsp;=\u0026thinsp;0.07) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of perioperative surgical parameters between the two groups (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental group (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperation time, min\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e89.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePuncture time, min\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;28.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScrew placement time, min\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFluoroscopy frequency, times\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal incision length per segment, cm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative blood loss, ml\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e93.5\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative bed rest duration, days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of hospital stay, days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026asymp;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparison of pedicle screw placement accuracy\u003c/h2\u003e \u003cp\u003eA total of 268 screws were inserted in the experimental group, including 228 Grade A screws (85.1%), 30 Grade B screws (11.2%), and 10 Grade C or higher screws (3.7%). In the control group, 304 screws were inserted, including 256 Grade A screws (84.2%), 36 Grade B screws (11.8%), and 12 Grade C or higher screws (3.9%). There were no significant differences in the distribution of screw grades between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe perfect accuracy rate (Grade A) was 85.10% in the experimental group and 84.20% in the control group (χ\u0026sup2; = 0.08, P\u0026thinsp;=\u0026thinsp;0.78). The clinically acceptable accuracy rate (Grade A\u0026thinsp;+\u0026thinsp;B) was 96.3% in the experimental group and 96.1% in the control group (χ\u0026sup2; = 0.01, P\u0026thinsp;=\u0026thinsp;0.93) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of pedicle screw placement accuracy between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental group (n\u0026thinsp;=\u0026thinsp;268 screws)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;304 screws)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompletely within the pedicle (Grade A)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228 (85.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256 (84.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCortical breach\u0026thinsp;\u0026lt;\u0026thinsp;2 mm (Grade B)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCortical breach\u0026thinsp;\u0026ge;\u0026thinsp;2 mm (Grade C or above)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerfect accuracy (Grade A)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinically acceptable accuracy (Grade A\u0026thinsp;+\u0026thinsp;B)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e292 (96.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: Perfect accuracy\u0026thinsp;=\u0026thinsp;Grade A; clinically acceptable accuracy\u0026thinsp;=\u0026thinsp;Grade A\u0026thinsp;+\u0026thinsp;B.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Comparison of radiographic outcomes\u003c/h2\u003e \u003cp\u003eThe preoperative anterior vertebral height ratio was 62.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7% in the experimental group and 63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1% in the control group, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.70). At the final follow-up, the values were 91.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5% and 90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8%, respectively, also with no significant difference (P\u0026thinsp;=\u0026thinsp;0.44). The restoration value of the anterior vertebral height ratio was 28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9% in the experimental group and 27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2% in the control group, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.46).\u003c/p\u003e \u003cp\u003e The preoperative local Cobb angle was 18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u0026deg; in the experimental group and 19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u0026deg; in the control group (P\u0026thinsp;=\u0026thinsp;0.71). At the final follow-up, the angles were 6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u0026deg; and 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u0026deg;, respectively (P\u0026thinsp;=\u0026thinsp;0.58). The Cobb angle correction was 12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u0026deg; in the experimental group and 12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u0026deg; in the control group, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.91) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of radiographic parameters between the two groups (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental group (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior vertebral height ratio (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e62.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e91.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eΔ (final \u0026ndash; preoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocal Cobb angle (\u0026deg;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eΔ (preoperative \u0026ndash; final)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Δ values represent changes from baseline.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Clinical outcomes and complications\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1 Pain and functional outcomes\u003c/h2\u003e \u003cp\u003eThe preoperative VAS score was 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 in the experimental group and 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;0.70, P\u0026thinsp;=\u0026thinsp;0.49). On postoperative day 3, the VAS score was 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 in the experimental group and 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;1.86, P\u0026thinsp;=\u0026thinsp;0.065). At the final follow-up, the VAS score was 1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 in the experimental group and 1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;1.05, P\u0026thinsp;=\u0026thinsp;0.30). The VAS improvement was 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 and 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 in the experimental and control groups, respectively, with no significant difference (t\u0026thinsp;=\u0026thinsp;1.26, P\u0026thinsp;=\u0026thinsp;0.21).\u003c/p\u003e \u003cp\u003eThe preoperative ODI was 58.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2% in the experimental group and 59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0% in the control group (t\u0026thinsp;=\u0026thinsp;0.73, P\u0026thinsp;=\u0026thinsp;0.47). At the final follow-up, the ODI was 15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1% and 16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6% in the two groups, respectively (t\u0026thinsp;=\u0026thinsp;0.90, P\u0026thinsp;=\u0026thinsp;0.37). The ODI improvement was 42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4% in the experimental group and 43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7% in the control group, with no significant difference (t\u0026thinsp;=\u0026thinsp;0.20, P\u0026thinsp;=\u0026thinsp;0.84).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2 Complications\u003c/h2\u003e \u003cp\u003eNo cases of screw cut-out or obvious cortical breach occurred in the experimental group, whereas 2 cases (2.6%) occurred in the control group, with no significant difference (χ\u0026sup2; = 2.01, P\u0026thinsp;=\u0026thinsp;0.16). One case (1.5%) of transient nerve root irritation was observed in the experimental group and 2 cases (2.6%) in the control group, with no significant difference (χ\u0026sup2; = 0.23, P\u0026thinsp;=\u0026thinsp;0.63). One case of superficial wound infection occurred in each group (1.5% vs. 1.3%), with no significant difference (P\u0026thinsp;=\u0026thinsp;0.93).\u003c/p\u003e \u003cp\u003eNo reoperations were performed in the experimental group, whereas 2 cases (2.6%) required reoperation in the control group, with no significant difference (χ\u0026sup2; = 2.01, P\u0026thinsp;=\u0026thinsp;0.16) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical outcomes and postoperative complications between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperimental group (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et / χ\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative day 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eODI (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVAS improvement (preoperative \u0026ndash; final)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eODI improvement (preoperative \u0026ndash; final)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScrew cut-out / significant cortical breach, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.16*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransient nerve root irritation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuperficial wound infection, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReoperation rate, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.16*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: VAS, Visual Analog Scale; ODI, Oswestry Disability Index.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*P value from χ\u0026sup2; test; values marked with * may be limited by low expected frequencies.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e4.1 Impact of the posture-sensing and blind guidewire probing techniques on operative efficiency and radiation exposure\u003c/p\u003e \u003cp\u003eAlthough percutaneous pedicle screw placement has been widely used in the minimally invasive treatment of thoracolumbar compression fractures, its heavy dependence on C-arm fluoroscopy remains a major limiting factor for further optimization. Gelalis et al. \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e reported in a systematic review that, during conventional fluoroscopy-guided percutaneous screw placement, each screw typically requires an average of 8\u0026ndash;12 fluoroscopic acquisitions, and more than 15 exposures may be needed in complex segments. Laine et al. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, based on dosimetric analysis, found that the annual cumulative radiation dose for spine surgeons performing minimally invasive procedures can approach the upper limit of occupational exposure, posing a potential long-term occupational hazard.\u003c/p\u003e \u003cp\u003eIn the present study, the number of fluoroscopy exposures in the experimental group was only 5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4, which was significantly lower than 15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 in the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At the same time, puncture time, screw placement time, and total operation time were all markedly reduced in the experimental group. These findings are consistent with the conclusions of Baba et al. \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e and Kato et al. \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, who reported that trajectory guidance based on tactile feedback and spatial orientation can significantly reduce dependence on fluoroscopy. Baba et al. demonstrated in cadaveric experiments that, once a stable tactile\u0026ndash;image correlation is established, surgeons can safely perform screw placement with minimal fluoroscopic verification \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe underlying mechanism is as follows: the posture-sensing method reconstructs a tactile \u0026ldquo;map\u0026rdquo; from surface to deep structures, integrating the transverse process, superior articular process, and pedicle axis, thereby enabling the surgeon to form a relatively stable three-dimensional spatial model before puncture. The blind guidewire probing technique utilizes the clear difference between the \u0026ldquo;continuous resistance feedback\u0026rdquo; in cancellous bone and the \u0026ldquo;blocking feedback\u0026rdquo; in front of cortical bone, guiding the guidewire to follow the natural cancellous channel. The combination of these two techniques allows the surgeon to safely advance the guidewire in most cases without relying on repeated fluoroscopy. This shift from an \u0026ldquo;image-dominant\u0026rdquo; to a \u0026ldquo;tactile-dominant with image verification\u0026rdquo; mode is the key reason for the significant reduction in puncture and screw placement time in the experimental group.\u003c/p\u003e \u003cp\u003eFrom a radiation protection perspective, Motiei-Langroudi et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e pointed out that the radiation dose received by surgeons during a single percutaneous screw placement procedure is positively correlated with the number of fluoroscopic exposures. In the present study, the ~\u0026thinsp;63% reduction in fluoroscopy frequency in the experimental group indicates a substantial decrease in radiation exposure for both patients and surgeons. This has important occupational health implications, particularly in centers where minimally invasive spinal surgery is performed frequently.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Screw placement accuracy: comparison with conventional fluoroscopy and freehand techniques\u003c/h2\u003e \u003cp\u003eScrew placement accuracy is always a core indicator for evaluating the safety of any pedicle screw technique. The CT-based grading system proposed by Gertzbein and Robbins \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e remains the international standard and has been widely used in comparative studies of freehand, fluoroscopy-guided, navigation-assisted, and robot-assisted screw placement. Gelalis et al. \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, in a systematic review of 37 clinical studies, reported that the proportion of Grade A screws with freehand and conventional fluoroscopy-assisted techniques typically ranges from 80% to 88%, with clinically acceptable rates exceeding 95%.\u003c/p\u003e \u003cp\u003eIn the present study, the Grade A rate in the experimental group was 85.1%, and the clinically acceptable rate was 96.3%, which were not significantly different from those in the control group and were highly consistent with the above international data. Motiei-Langroudi et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e reported a Grade A rate of 83.4% and a Grade B rate of approximately 13% for conventional fluoroscopy-guided pedicle screw placement in the thoracolumbar spine, which is very similar to the results in our control group. These findings indicate that, while reducing dependence on fluoroscopy, the posture-sensing plus blind guidewire probing technique does not compromise screw placement accuracy.\u003c/p\u003e \u003cp\u003eFrom a biomechanical and anatomical perspective, the safety of this technique is based on the fact that the guidewire advances along the path of least resistance within the pedicle cancellous bone, naturally avoiding cortical bone and forming a \u0026ldquo;self-feedback safety trajectory.\u0026rdquo; When approaching the medial or lateral wall of the pedicle, resistance increases significantly, prompting the surgeon to immediately withdraw and adjust the direction, thereby avoiding catastrophic breach. The absence of obvious cortical violations in the experimental group further confirms, from a clinical standpoint, the reliability of this tactile-guided \u0026ldquo;safety channel.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Explanation for the lack of between-group differences in radiographic correction and clinical outcomes\u003c/h2\u003e \u003cp\u003eIn this study, there were no significant differences between the two groups in terms of anterior vertebral height restoration, Cobb angle correction, or radiographic parameters at the final follow-up. Similarly, improvements in VAS and ODI scores did not differ significantly between groups. These findings are highly consistent with the results of multiple retrospective studies and meta-analyses conducted by Phan et al. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, Wang et al. \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, Han et al. \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, and Mittal et al. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Phan et al. pointed out in their systematic review that in patients with single-level thoracolumbar compression fractures, the long-term radiographic and functional outcomes are only minimally influenced by the type of screw placement assistance used \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrom a biomechanical perspective, radiographic correction is determined primarily by the reduction maneuver, stiffness of the screw\u0026ndash;rod construct, and restoration of posterior tension band structures, rather than by the specific method used to introduce the guidewire into the pedicle. As long as a symmetric and reliable bilateral fixation pathway is established, it is reasonable that different safe screw placement techniques would yield similar postoperative correction and long-term maintenance.\u003c/p\u003e \u003cp\u003eSimilarly, improvements in VAS and ODI scores are more closely related to fracture stabilization, early mobilization, and the quality of postoperative rehabilitation than to the screw placement technique per se. Therefore, the present findings indirectly suggest that the core value of the posture-sensing plus blind guidewire probing technique does not lie in \u0026ldquo;superior clinical efficacy,\u0026rdquo; but rather in \u0026ldquo;achieving equivalent efficacy at a lower procedural cost.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Comparison and positioning relative to navigation and robot-assisted technologies\u003c/h2\u003e \u003cp\u003eIn recent years, computer navigation and robot-assisted percutaneous pedicle screw systems have been regarded as important advances for improving screw placement accuracy. Multiple meta-analyses by Tarawneh et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, Matur et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, Peng et al. \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, and Tovar et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e] consistently demonstrated that robot-assisted screw placement can achieve Grade A rates exceeding 90%, with significantly lower rates of severe malposition compared with freehand techniques. Sun et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e and Al-Naseem et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e further noted that robotic systems may reduce additional trauma related to repeated intraoperative adjustments.\u003c/p\u003e \u003cp\u003eHowever, nearly all of these studies also emphasize the limitations of robotic systems, including high equipment costs, complex preoperative preparation, a strong reliance on accurate image registration, and the need to convert to conventional techniques in cases of system failure or registration error. Moreover, robotic systems do not fundamentally eliminate dependence on fluoroscopy, as multiple imaging checks are still required for intraoperative calibration.\u003c/p\u003e \u003cp\u003eIn contrast, the posture-sensing plus blind guidewire probing technique used in the present study does not require any additional hardware and relies entirely on the surgeon\u0026rsquo;s tactile perception and spatial orientation to complete key steps. Although its Grade A rate does not reach the extremely high levels reported for robotic systems, it meets internationally recognized thresholds for clinical safety and offers unique advantages in terms of cost, accessibility, low equipment dependence, and suitability for primary hospitals. Therefore, this technique is better positioned as an \u0026ldquo;optimal percutaneous screw placement strategy in settings without high-end equipment.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Current status of research and implications for promotion in primary hospitals\u003c/h2\u003e \u003cp\u003eGlobally, developed healthcare systems are increasingly focusing on digital upgrading through navigation and robotic technologies \u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. In contrast, in many developing countries and resource-limited regions, freehand and fluoroscopy-assisted techniques remain the mainstream approaches for percutaneous pedicle screw placement. In a multicenter study from resource-limited settings, Mittal et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e pointed out that freehand percutaneous pedicle screw fixation remains the most practical choice due to its low equipment dependence and ease of implementation.\u003c/p\u003e \u003cp\u003eIn China, numerous studies have focused on \u0026ldquo;improving screw placement safety in the absence of navigation.\u0026rdquo; Peng et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e proposed a localization strategy based on the tangent of the supraspinous ligament; Jetjumnong et al. \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e introduced a modified Qi technique; and He et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e optimized freehand placement based on the SAP principle. All of these approaches demonstrated that refined application of anatomical landmarks can maintain high screw placement safety without navigation. The posture-sensing method in the present study represents a further development within this technical framework. Its innovation lies in the first systematic incorporation of tactile feedback into the percutaneous screw placement workflow, and in verifying its safety and efficacy through a clinical comparative study.\u003c/p\u003e \u003cp\u003eThis feature confers substantial potential for widespread adoption in secondary hospitals and primary spine centers in China, enabling improvement in the overall safety and efficiency of minimally invasive pedicle screw placement without significantly increasing medical costs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Learning curve and standardization of the technique\u003c/h2\u003e \u003cp\u003eThe posture-sensing and blind guidewire probing technique is clearly operator-dependent. During the initial learning phase, surgeons still need to rely on repeated fluoroscopy to establish the correlation among tactile perception, imaging findings, and spatial orientation. With increasing experience, tactile feedback gradually becomes the primary source of information, and the number of fluoroscopic exposures decreases significantly. The significantly fewer fluoroscopy shots in the experimental group in this study suggest that, once mastered, this technique can form a stable and efficient operative pattern.\u003c/p\u003e \u003cp\u003eUnlike the \u0026ldquo;device-based learning curve\u0026rdquo; of robotic systems, this technique involves a \u0026ldquo;continuous benefit learning curve,\u0026rdquo; where benefits persist once skills are acquired. A standardized training pathway should include:\u003c/p\u003e \u003cp\u003e(1) Systematic training in anatomical and tactile recognition;\u003c/p\u003e \u003cp\u003e(2) A stepwise transition from fluoroscopy-dependent to tactile-dominant operation;\u003c/p\u003e \u003cp\u003e(3) Strict selection of indications in the early phase (e.g., single-level fractures and segments with relatively large pedicles).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Complications and safety evaluation\u003c/h2\u003e \u003cp\u003eIn this study, the overall complication rates were low in both groups, with no significant between-group differences. No cases of screw cut-out or reoperation occurred in the experimental group, and only one case of transient nerve root irritation was observed. In contrast, the control group had 2 cases of screw cut-out and 2 cases requiring reoperation. Motiei-Langroudi et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e and Mittal et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e reported in large-sample studies that the incidence of screw cut-out after percutaneous pedicle screw fixation is approximately 2%\u0026ndash;5%, which is similar to the findings in our control group.\u003c/p\u003e \u003cp\u003eThe low complication rate in the experimental group suggests that, when indications are strictly observed and the technique is performed by experienced surgeons, the posture-sensing plus blind guidewire probing method does not increase the risk of neurological injury or implant failure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.8 Study limitations\u003c/h2\u003e \u003cp\u003eDespite its clinical relevance, this study has several limitations:\u003c/p\u003e \u003cp\u003e(1) The single-center retrospective design inevitably introduces selection bias.\u003c/p\u003e \u003cp\u003e(2) The sample size was relatively limited, and the number of certain complications was small.\u003c/p\u003e \u003cp\u003e(3) No subgroup analysis was performed based on different surgeons or learning stages.\u003c/p\u003e \u003cp\u003e(4) The follow-up period was mainly mid-term, and long-term issues such as implant failure and adjacent segment degeneration could not be fully assessed.\u003c/p\u003e \u003cp\u003e(5) Objective radiation dose measurements were not included; fluoroscopy frequency was used only as an indirect indicator.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, the posture-sensing method combined with blind guidewire probing for percutaneous pedicle screw placement in patients with single-level thoracolumbar compression fractures can significantly shorten operative time, reduce fluoroscopy exposure, and decrease intraoperative blood loss, while maintaining screw placement accuracy, radiographic reduction outcomes, and clinical efficacy comparable to those achieved with conventional fluoroscopy-guided techniques. Compared with navigation- and robot-assisted technologies, this technique shows clear advantages in terms of cost, equipment dependence, and accessibility in primary hospitals. With standardized training and strict selection of indications, this method is expected to serve as a cost-effective percutaneous screw placement strategy and to be applied in a broader range of clinical settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArbeitsgemeinschaft f\u0026uuml;r Osteosynthesefragen (Association for the Study of Internal Fixation)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHounsfield unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIMU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInertial measurement unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eODI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOswestry Disability Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior articular process\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTLICS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThoracolumbar Injury Classification and Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analogue scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments. The study protocol was reviewed and approved by the Ethics Committee of the Affiliated 960th Hospital of the PLA (Approval No. 2025084). Given the retrospective design and the use of anonymized clinical data, the requirement for written informed consent was waived by the Ethics Committee of the Affiliated 960th Hospital of the PLA in accordance with relevant national regulations.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This study was a retrospective analysis using anonymized clinical data, and no individual patient-identifiable information is included in this publication.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional regulations regarding patient data confidentiality, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eXin Xu and Fuxin Wang contributed equally to this study as co-first authors. Xin Xu, Fuxin Wang, and Kun Wang participated in study design, data collection, and statistical analysis, and were major contributors to manuscript drafting. Ang Li and Junlin Han were responsible for clinical data management, imaging measurements, and figure preparation. Ruoxian Song and Zheng Zhang supervised the entire research process, critically revised the manuscript for important intellectual content, and approved the final version for submission. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank the medical and nursing staff of the Department of Spine Surgery, Affiliated 960th Hospital of the PLA, for their support in patient care and data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZileli M, Sharif S, Fornari M. Incidence and epidemiology of thoracolumbar spine fractures: WFNS Spine Committee recommendations. Neurospine. 2021;18(4):704\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood KB, Li W, Lebl DS, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: a systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang B, L\u0026uuml; G, Patel AA, et al. A retrospective study comparing percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinal injury. Med (Baltim). 2017;96(38):e8104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan JY, Kim KT, Kim SM, et al. Comparison of percutaneous versus open pedicle screw fixation in thoracolumbar fractures. J Korean Fract Soc. 2020;33(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMittal S, Rana A, Ahuja K, et al. Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoracolumbar burst fractures. Int J Res Orthop. 2021;7(2):286\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu J, Chen YN, Hu MW, et al. Systematic review and meta-analysis of the effect of percutaneous pedicle screw internal fixation for thoracolumbar fractures. Ann Palliat Med. 2022;11(1):xxx\u0026ndash;xxx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine. 1990;15(1):11\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing freehand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaine T, Schlenzka D, M\u0026auml;kitalo K, et al. Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J. 1997;6(6):402\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMotiei-Langroudi R, Rahmanian A, Sadeghian H, et al. Assessment of pedicle screw placement accuracy in thoracolumbar spine using conventional methods. J Clin Neurosci. 2015;22(5):879\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarawneh AM, Salem KM, Allam Y, et al. A systematic review and meta-analysis of randomized controlled trials comparing the accuracy of robot-assisted versus conventional freehand pedicle screw placement. Global Spine J. 2021;11(1):22\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatur AV, Palmisciano P, Chaurasia B, et al. Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand pedicle screws: a systematic review and meta-analysis. Spine J. 2023;23(4):617\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng YN, Tsai LC, Hsu HC, Kao CH. Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Transl Med. 2020;8(13):824.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTovar MA, Osorio JA, Makhni MC, et al. Robot-assisted pedicle screw placement versus conventional techniques: a systematic review and meta-analysis of screw accuracy. J Neurosurg Spine. 2022;37(2):299\u0026ndash;311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun WX, Wang X, Li J, et al. Is robot-assisted pedicle screw placement really superior to conventional techniques? A systematic review and meta-analysis. EFORT Open Rev. 2024;9(11):e24\u0026ndash;0062.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Naseem AO, Kieser DC, Kandziora F, et al. Robot-assisted pedicle screw placement versus navigation-guided and conventional techniques: a systematic review and meta-analysis. Eur Spine J. 2024;33(5):xxx\u0026ndash;xxx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaba S, Kawaguchi K, Itamoto K, et al. Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy. PLoS ONE. 2020;15(11):e0242512.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKato G, Baba S, Kawaguchi K et al. Inertial measurement unit\u0026ndash;assisted implantation of thoracic, lumbar and sacral pedicle screws improves precision of a freehand technique. Spine. (ahead of print).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvila MJ, Baaj AA. Freehand thoracic pedicle screw placement: review of existing strategies and a step-by-step guide using uniform landmarks for all levels. Cureus. 2016;8(2):e501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng F, Gao R, Xie Q, et al. Supraspinous ligament arc tangent guided freehand thoracic pedicle screw insertion technique: analysis of screw position and angle between screws and upper endplate. Front Surg. 2023;10:1219816.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJetjumnong C, Norasetthada T. Accuracy and outcomes of freehand thoracic pedicle screw placement using Qi\u0026rsquo;s technique. J Health Sci Med Res. 2022;40(5):561\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe J, Zhang H, Jiang Y, et al. SAP principle\u0026ndash;guided free hand technique: a secret for accurate and safe thoracic and lumbar pedicle screw insertion. Orthop Surg. 2022;14(5):919\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCueva GAJN, Velasco V, Rivas L, et al. Free hand technique for placement of transpedicular screws in thoracolumbar spine: is it safe? Rev Mex Ortop Traum. 2022;36(2):xxx\u0026ndash;xxx.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMittal S, Rana A, Ahuja K, et al. Pattern of spine fracture in resource-limited regions and implications for freehand pedicle screw fixation. J Clin Orthop Trauma. 2021;15:27\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thoracolumbar compression fracture, Percutaneous pedicle screw fixation, Posture-sensing technique, Blind guidewire probing, Minimally invasive spine surgery, Radiation exposure","lastPublishedDoi":"10.21203/rs.3.rs-8252605/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8252605/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePercutaneous pedicle screw fixation is widely used for the minimally invasive treatment of single-level thoracolumbar compression fractures. However, the conventional fluoroscopy-guided technique requires repeated imaging, resulting in increased radiation exposure and prolonged operative time. This study aimed to evaluate the clinical efficacy, safety, and efficiency of a posture-sensing method combined with blind guidewire probing for percutaneous pedicle screw placement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis single-center retrospective comparative study included 143 patients with single-level thoracolumbar compression fractures treated between January 2021 and December 2023. Patients were divided into the experimental group (posture-sensing combined with blind guidewire probing, n\u0026thinsp;=\u0026thinsp;67) and the control group (conventional fluoroscopy-guided technique, n\u0026thinsp;=\u0026thinsp;76). Perioperative parameters, pedicle screw accuracy based on the Gertzbein\u0026ndash;Robbins classification, radiographic outcomes, clinical outcomes (VAS and ODI), and postoperative complications were compared between groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe experimental group showed significantly shorter operation time (48.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 vs. 89.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5 min), puncture time (7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 vs. 24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 min), fewer fluoroscopy exposures (5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 vs. 15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8), and less intraoperative blood loss (51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8 vs. 93.5\u0026thinsp;\u0026plusmn;\u0026thinsp;36.2 mL) than the control group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The perfect screw placement rate (Grade A) was 85.1% in the experimental group and 84.2% in the control group (P\u0026thinsp;=\u0026thinsp;0.78), and the clinically acceptable rate (Grade A\u0026thinsp;+\u0026thinsp;B) was 96.3% and 96.1%, respectively (P\u0026thinsp;=\u0026thinsp;0.93). No significant differences were observed in radiographic restoration, VAS, ODI, or their improvement values between groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Overall complication rates were low and comparable between groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe posture-sensing method combined with blind guidewire probing significantly reduces operative time, fluoroscopy exposure, and blood loss while maintaining comparable screw accuracy, radiographic outcomes, and clinical efficacy to the conventional fluoroscopy-guided technique. This method is a safe, efficient, and cost-effective alternative for percutaneous pedicle screw placement, particularly in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Application of a Posture-Sensing Method Combined With Blind Guidewire Probing in Percutaneous Pedicle Screw Placement for Single-Level Thoracolumbar Compression Fractures: A Retrospective Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 10:03:46","doi":"10.21203/rs.3.rs-8252605/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T08:27:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-12T09:12:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97962889482719772072682056882371606070","date":"2026-01-12T01:59:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206389878322090497875148187319574163919","date":"2025-12-26T15:49:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200821461134790353187027159649820210331","date":"2025-12-23T05:54:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111457862285518046638747113302738739837","date":"2025-12-17T11:55:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-17T09:14:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T13:40:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-09T13:35:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-12-01T16:32:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8bc8d395-fd7e-4d42-a3c2-49833c275b3f","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:31:54+00:00","versionOfRecord":{"articleIdentity":"rs-8252605","link":"https://doi.org/10.1186/s13018-026-06754-y","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2026-03-24 16:10:24","publishedOnDateReadable":"March 24th, 2026"},"versionCreatedAt":"2025-12-22 10:03:46","video":"","vorDoi":"10.1186/s13018-026-06754-y","vorDoiUrl":"https://doi.org/10.1186/s13018-026-06754-y","workflowStages":[]},"version":"v1","identity":"rs-8252605","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8252605","identity":"rs-8252605","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}