How to Insert Thoracolumbar Pedicle Screws? Let AO Principles Guide You

Meta Title: Thoracolumbar Pedicle Screw Insertion Guide – Step-by-Step AO Technique

Meta Description: Learn how to insert thoracolumbar pedicle screws accurately and safely with this AO-based 7-step guide. Covers entry point location, angle control, and intraoperative risks.

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Why Pedicle Screw Insertion Matters in Spine Surgery

Pedicle screw fixation is the cornerstone of spinal surgery for trauma, degeneration, or deformity correction. It offers strong three-dimensional stabilization—but improper insertion can result in neural injury, screw loosening, or cortical breach.

In this guide, we’ll walk you through 7 critical steps of thoracolumbar pedicle screw insertion, based on AO principles and clinical best practices.

✅ Keywords targeted: thoracolumbar pedicle screw insertion, spine fixation technique, pedicle screw entry point, spinal instrumentation

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Step 1: Preoperative Planning with Imaging

Expose the spine and confirm the surgical levels using fluoroscopy or navigation tools.

In unstable spinal injuries, vertebral rotation or displacement may alter pedicle alignment—making screw trajectory more difficult and risk-prone.

Always assess pedicle integrity for all levels intended for fixation.

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Step 2: Precise Pedicle Screw Entry Point Localization

Lumbar Spine:

Locate the entry point at the intersection of four key anatomical landmarks:

• Pars interarticularis
• Mamillary process
• Lateral border of the superior articular facet
• Midpoint of the transverse process

Thoracic Spine:

For lower thoracic levels, the entry point lies just lateral and caudal to the junction between:

• Mid-facet joint
• Superior edge of the transverse process

For more proximal thoracic segments, shift the entry more cephalad (towards the head).

✅ Long-tail keyword example: how to locate thoracic pedicle screw entry point

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Step 3: Opening the Cortical Bone

Use a burr or rongeur to open the outer cortex at the marked entry point.

Avoid using the pedicle awl aggressively in highly unstable segments to prevent further displacement.

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Step 4: Cranial-Caudal Angulation (Vertical Trajectory)

Advance the pedicle probe through the isthmus of the pedicle into the vertebral body.

The correct cranial-caudal angle should aim toward the contralateral transverse process, staying parallel to the superior endplate.

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Step 5: Medial-Lateral Angulation (Horizontal Trajectory)

The ideal medio-lateral angulation depends on vertebral level and rotation:

Segment	Approx. Angulation	Surgical Risk
T5	~0°	Risk of medial canal breach
L5	Up to 45°	Risk of anterior/lateral breach

Key goal:

Avoid medial breach into spinal canal, and lateral/anterior perforation of the vertebral cortex at depth.

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Step 6: Pedicle Track Verification

After the trajectory is created, use a pedicle sounder/probe to check bony integrity.

Intraoperative fluoroscopy can be used anytime for confirmation.

✅ Targeted keywords: pedicle screw track integrity, intraoperative screw verification

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Step 7: Screw Insertion and Type Selection

Once the channel is verified, insert the screw. You may choose between:

• Monoaxial screws for rigid fixation
• Polyaxial screws for better rod accommodation

Ensure both screws are converging and entirely contained within the pedicle and vertebral body cortex.

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Key Takeaways for Safe and Accurate Pedicle Screw Placement

• Perform thorough imaging-based planning.
• Identify anatomical entry points based on spinal level.
• Control both vertical and horizontal screw angles.
• Verify the track before screw insertion.
• Choose screw types based on surgical goals.

By following these principles, you ensure optimal fixation strength while minimizing the risk of neurological or vascular injury.

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Further Reading

• 👉 Top 5 Reasons for Pedicle Screw Loosening and How to Prevent Them
• 👉 Common Complications in Spine Fixation: What Surgeons Must Know
• 👉 Choosing the Right Pedicle Screw: Monoaxial vs Polyaxialhttps://youtu.be/oxPcSU-VL8I

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Want Reliable Pedicle Screw Systems?

If you’re a spine surgeon or procurement specialist, contact HOPE Medical for our full line of thoracolumbar pedicle screw systems.

📩 WhatsApp: +86 139 1569 6091

📧 Email: [email protected]

🌐 Website: www.js-hp.com/en/

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FAQs

Q1: Why is L5 pedicle screw insertion more challenging?

Because of its high medial angulation (up to 45°) and risk of anterior breach—careful trajectory control is essential.

Q2: When should I choose polyaxial screws over monoaxial?

Polyaxial screws are more flexible during rod assembly, especially in multi-level constructs, but monoaxial may provide stronger biomechanical stability.

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Hashtags

#PedicleScrew #SpineSurgery #ThoracolumbarFixation #OrthopedicImplants #HOPEMedical #SpinalInstrumentation #SurgicalTechnique #AOPrinciples #SpinalStabilization #Orthopedicsurgery

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