Evidence map›Paper›PMID 40965516›Full record

ArticleNeurosurgical review2025

Tricortical screw spinal fixation: a scoping review and introduction of technique, biomechanical advantages, and clinical outcomes in high-risk vertebral fractures.

Hanyu Qiu, Daniel O'Connor, Kishore Balasubramanian, Graham G Mulvaney, Beste Gulsuna, Abigail A York, Chao Li DO

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Hanyu Qiu *Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Daniel O'Connor *Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Kishore BalasubramanianDepartment of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Graham G MulvaneyDepartment of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Beste GulsunaDepartment of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Abigail A YorkDepartment of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Chao Li DODepartment of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. chao-li-1@ouhsc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectiveTricortical pedicle screw (TCPS) fixation has emerged as a biomechanically superior alternative to conventional unicortical/bicortical methods for spinal stabilization in high-risk populations, particularly elderly patients with osteoporotic or diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures. This review evaluates TCPS fixation's biomechanical advantages, clinical outcomes, and surgical considerations to address these challenges.

methodsA scoping review was conducted using the PRISMA scoping review checklist. PubMed was searched through March 1, 2025. Inclusion criteria were studies reporting treatment parameters and follow-up results of TCPS spinal fixation. Data was analyzed to synthesize clinical outcomes, with a focus on hardware failure rates.

results5 studies satisfied the final inclusion criteria, consisting of 3 case series and 2 cohorts. These 5 studies included 85 patient cases. The included patients had a weighted mean age of 78.97 years, with a sex distribution consisting of 54.8% (n = 40) males and 45.2% (n = 33) females. 62.4% (n = 53) patients were positive for DISH. Affected vertebrae were mostly located in the thoracolumbar region (64.1%), followed by the thoracic (21.8%) and lumbar regions (14.1%). 76.5% (n = 65) of patients were treated with TCPS fixation, and 23.5% (n = 20) were treated conventionally. A total of 636 screws were inserted, consisting of 46.2% (n = 294) tricortical and 53.8% (n = 342) conventional pedicle screws. Of the tricortical screws, 1.36% (n = 4) loosened, while 20.5% (n = 70) of conventional screws loosened. 3 patients treated with TCPS fixation experienced implant failure, while 6 patients treated with conventional pedicle screw fixation experienced implant failure.

conclusionTCPS fixation enhances spinal stabilization in high-risk fractures through tri-cortical load distribution, minimizing screw loosening and invasiveness. While requiring precise trajectory planning to avoid perforation risks, it offers shorter operative times, reduced blood loss, and improved biomechanical stability, particularly in osteoporotic/DISH patients. Further prospective studies are needed to optimize patient selection and refine navigation-assisted techniques for broader applicability.

Indexed as

Fracture Fixation, InternalPedicle ScrewsSpinal FracturesSpinal FusionAgedBiomechanical PhenomenaFemaleHumansLumbar VertebraeMaleThoracic VertebraeTreatment OutcomePedicle screwPenetrating endplate screwSpinal fixationTricortical screw fixation

Identifiers

PMID40965516
PMCPMC12446397

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.