{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:25:34Z","timestamp":1786980334235,"version":"build-2736575974"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purposes<\/jats:title>\n                    <jats:p>An optimal pedicle screw density for spinal deformity correction in adolescent idiopathic scoliosis (AIS) remains poorly defined. We compared radiographic correction, operative time, estimated blood loss, and implant cost among different screw density patterns in operatively treated AIS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective observational cohort study of AIS patients who underwent posterior spinal fusion using all-pedicle screw instrumentation was conducted from January 2012 to December 2018. All patients were categorized into three different pedicle screw density groups: the very low density (VLD), the low density (LD), and the high density (HD) group. The comparative effectiveness between each pairwise comparison was performed under the inverse probability of the treatment weighting method to minimize the possible confounders imbalance among treatment groups. The primary endpoints in this study were the degrees of correction and deformity progression at 2\u00a0years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 174 AIS patients were included in this study. The adjusted treatment effects demonstrated similar degrees of deformity correction after 2\u00a0years in the three treatment groups. However, the VLD and LD group slightly increased the curve progression at 2\u00a0years compared to the HD group by 3.9\u00b0 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and 3.2\u00b0 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044), respectively. Nevertheless, the limited screw density patterns (VLD and LD) significantly reduced the operative time, estimated blood loss, and implant cost per operated level.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The limited pedicle screw pattern (VLD and LD) in relatively flexible AIS spinal deformity correction results in similar coronal and sagittal radiological outcomes while reducing operative time, estimated blood loss, and implant cost compared to the high-density pedicle screw instrumentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-023-07615-6","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:02:37Z","timestamp":1680134557000},"page":"2203-2212","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparative effectiveness of different pedicle screw density patterns in spinal deformity correction of small and flexible operative adolescent idiopathic scoliosis: inverse probability of treatment weighting analysis"],"prefix":"10.1007","volume":"32","author":[{"given":"Chatupon","family":"Chotigavanichaya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nath","family":"Adulkasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirachai","family":"Pisutbenya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monchai","family":"Ruangchainikom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panya","family":"Luksanapruksa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirichai","family":"Wilartratsami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanase","family":"Ariyawatkul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkapoj","family":"Korwutthikulrangsri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"7615_CR1","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1016\/s0140-6736(08)60658-3","volume":"371","author":"SL Weinstein","year":"2008","unstructured":"Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527\u20131537. https:\/\/doi.org\/10.1016\/s0140-6736(08)60658-3","journal-title":"Lancet"},{"key":"7615_CR2","doi-asserted-by":"publisher","first-page":"519","DOI":"10.31616\/asj.2018.0096","volume":"13","author":"SR Kikanloo","year":"2019","unstructured":"Kikanloo SR, Tarpada SP, Cho W (2019) Etiology of adolescent idiopathic scoliosis: a literature review. Asian Spine J 13:519\u2013526. https:\/\/doi.org\/10.31616\/asj.2018.0096","journal-title":"Asian Spine J"},{"key":"7615_CR3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/s13018-018-0928-5","volume":"13","author":"J Wang","year":"2018","unstructured":"Wang J, Zhang J, Xu R, Chen TG, Zhou KS, Zhang HH (2018) Measurement of scoliosis Cobb angle by end vertebra tilt angle method. J Orthop Surg Res 13:223. https:\/\/doi.org\/10.1186\/s13018-018-0928-5","journal-title":"J Orthop Surg Res"},{"key":"7615_CR4","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1097\/00007632-199805010-00021","volume":"23","author":"R Xu","year":"1998","unstructured":"Xu R, Ebraheim NA, Ou Y, Yeasting RA (1998) Anatomic considerations of pedicle screw placement in the thoracic spine Roy-Camille technique versus open-lamina technique. Spine 23:1065\u20131068. https:\/\/doi.org\/10.1097\/00007632-199805010-00021","journal-title":"Spine"},{"key":"7615_CR5","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.2106\/00004623-199508000-00009","volume":"77","author":"AR Vaccaro","year":"1995","unstructured":"Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77:1200\u20131206. https:\/\/doi.org\/10.2106\/00004623-199508000-00009","journal-title":"J Bone Joint Surg Am"},{"key":"7615_CR6","first-page":"157","volume":"67","author":"U Liljenqvist","year":"2001","unstructured":"Liljenqvist U, Hackenberg L, Link T, Halm H (2001) Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67:157\u2013163","journal-title":"Acta Orthop Belg"},{"key":"7615_CR7","doi-asserted-by":"publisher","first-page":"2258","DOI":"10.1097\/BRS.0b013e31814b1ba6","volume":"32","author":"TR Kuklo","year":"2007","unstructured":"Kuklo TR, Potter BK, Lenke LG, Polly DW Jr, Sides B, Bridwell KH (2007) Surgical revision rates of hooks versus hybrid versus screws versus combined anteroposterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 32:2258\u20132264. https:\/\/doi.org\/10.1097\/BRS.0b013e31814b1ba6","journal-title":"Spine (Phila Pa 1976)"},{"key":"7615_CR8","doi-asserted-by":"publisher","first-page":"448","DOI":"10.3171\/2016.11.Peds16334","volume":"19","author":"M Luo","year":"2017","unstructured":"Luo M, Wang W, Shen M, Luo X, Xia L (2017) Does higher screw density improve radiographic and clinical outcomes in adolescent idiopathic scoliosis? A systematic review and pooled analysis. J Neurosurg: Pediatr PED 19:448\u2013457. https:\/\/doi.org\/10.3171\/2016.11.Peds16334","journal-title":"J Neurosurg: Pediatr PED"},{"key":"7615_CR9","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13013-017-0120-4","volume":"12","author":"X Wang","year":"2017","unstructured":"Wang X, Larson AN, Crandall DG, Parent S, Labelle H, Ledonio CGT, Aubin C-E (2017) Biomechanical effect of pedicle screw distribution in AIS instrumentation using a segmental translation technique: computer modeling and simulation. Scoliosis Spinal Disord 12:13. https:\/\/doi.org\/10.1186\/s13013-017-0120-4","journal-title":"Scoliosis Spinal Disord"},{"key":"7615_CR10","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1097\/BRS.0b013e3181b4af34","volume":"35","author":"GM Quan","year":"2010","unstructured":"Quan GM, Gibson MJ (2010) Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine (Phila Pa 1976) 35:562\u2013567. https:\/\/doi.org\/10.1097\/BRS.0b013e3181b4af34","journal-title":"Spine (Phila Pa 1976)"},{"key":"7615_CR11","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.spinee.2012.05.029","volume":"13","author":"NJ Bharucha","year":"2013","unstructured":"Bharucha NJ, Lonner BS, Auerbach JD, Kean KE, Trobisch PD (2013) Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: do more screws lead to a better outcome? Spine J 13:375\u2013381. https:\/\/doi.org\/10.1016\/j.spinee.2012.05.029","journal-title":"Spine J"},{"key":"7615_CR12","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.2106\/00004623-200108000-00006","volume":"83","author":"LG Lenke","year":"2001","unstructured":"Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169\u20131181","journal-title":"J Bone Joint Surg Am"},{"key":"7615_CR13","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1001\/jama.297.3.314","volume":"297","author":"RB D'Agostino Jr","year":"2007","unstructured":"D\u2019Agostino RB Jr, D\u2019Agostino RB Sr (2007) Estimating treatment effects using observational data. JAMA 297:314\u2013316. https:\/\/doi.org\/10.1001\/jama.297.3.314","journal-title":"JAMA"},{"key":"7615_CR14","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1093\/oxfordjournals.aje.a009758","volume":"149","author":"M Salas","year":"1999","unstructured":"Salas M, Hofman A, Stricker BH (1999) Confounding by indication: an example of variation in the use of epidemiologic terminology. Am J Epidemiol 149:981\u2013983. https:\/\/doi.org\/10.1093\/oxfordjournals.aje.a009758","journal-title":"Am J Epidemiol"},{"key":"7615_CR15","doi-asserted-by":"publisher","DOI":"10.3791\/59825","author":"JD Mitchell","year":"2020","unstructured":"Mitchell JD, Gage BF, Fergestrom N, Novak E, Villines TC (2020) Inverse probability of treatment weighting (propensity score) using the military health system data repository and national death index. J Vis Exp. https:\/\/doi.org\/10.3791\/59825","journal-title":"J Vis Exp"},{"key":"7615_CR16","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","volume":"28","author":"PC Austin","year":"2009","unstructured":"Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083\u20133107. https:\/\/doi.org\/10.1002\/sim.3697","journal-title":"Stat Med"},{"key":"7615_CR17","doi-asserted-by":"publisher","first-page":"833","DOI":"10.3928\/0147-7447-20000801-17","volume":"23","author":"PN Soucacos","year":"2000","unstructured":"Soucacos PN, Zacharis K, Soultanis K, Gelalis J, Xenakis T, Beris AE (2000) Risk factors for idiopathic scoliosis: review of a 6-year prospective study. Orthopedics 23:833\u2013838","journal-title":"Orthopedics"},{"key":"7615_CR18","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s005860050074","volume":"7","author":"PN Soucacos","year":"1998","unstructured":"Soucacos PN, Zacharis K, Gelalis J, Soultanis K, Kalos N, Beris A, Xenakis T, Johnson EO (1998) Assessment of curve progression in idiopathic scoliosis. Eur Spine J 7:270\u2013277. https:\/\/doi.org\/10.1007\/s005860050074","journal-title":"Eur Spine J"},{"key":"7615_CR19","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.2106\/jbjs.J.00678","volume":"93","author":"CG Ledonio","year":"2011","unstructured":"Ledonio CG, Polly DW Jr, Vitale MG, Wang Q, Richards BS (2011) Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force. J Bone Joint Surg Am 93:1227\u20131234. https:\/\/doi.org\/10.2106\/jbjs.J.00678","journal-title":"J Bone Joint Surg Am"},{"key":"7615_CR20","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1186\/s12891-017-1695-x","volume":"18","author":"M Shen","year":"2017","unstructured":"Shen M, Jiang H, Luo M, Wang W, Li N, Wang L, Xia L (2017) Comparison of low density and high density pedicle screw instrumentation in Lenke 1 adolescent idiopathic scoliosis. BMC Musculoskelet Disord 18:336. https:\/\/doi.org\/10.1186\/s12891-017-1695-x","journal-title":"BMC Musculoskelet Disord"},{"key":"7615_CR21","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/bpb.0000000000000754","volume":"30","author":"NN Wagala","year":"2021","unstructured":"Wagala NN, Marasigan JAM, Mian HM, Schwend RM (2021) Operative time in adolescent idiopathic scoliosis surgery: a need for a standard definition. J Pediatr Orthop B 30:205\u2013210. https:\/\/doi.org\/10.1097\/bpb.0000000000000754","journal-title":"J Pediatr Orthop B"},{"key":"7615_CR22","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12891-021-04104-z","volume":"22","author":"CYK Tang","year":"2021","unstructured":"Tang CYK, Kamath VHD, Cheung PWH, Cheung JPY (2021) Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis. BMC Musculoskelet Disord 22:225. https:\/\/doi.org\/10.1186\/s12891-021-04104-z","journal-title":"BMC Musculoskelet Disord"},{"key":"7615_CR23","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1007\/s00586-021-06817-0","volume":"30","author":"M Lenz","year":"2021","unstructured":"Lenz M, Oikonomidis S, Harland A, F\u00fcrnstahl P, Farshad M, Bredow J, Eysel P, Scheyerer MJ (2021) Scoliosis and Prognosis\u2014a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J 30:1813\u20131822. https:\/\/doi.org\/10.1007\/s00586-021-06817-0","journal-title":"Eur Spine J"},{"key":"7615_CR24","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1136\/bmj.307.6908.859","volume":"307","author":"R Robinson","year":"1993","unstructured":"Robinson R (1993) Cost-utility analysis. Br Med J 307:859\u2013862. https:\/\/doi.org\/10.1136\/bmj.307.6908.859","journal-title":"Br Med J"},{"key":"7615_CR25","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1177\/2192568218811312","volume":"9","author":"S Kato","year":"2018","unstructured":"Kato S, Murray J-C, Ganau M, Tan Y, Oshima Y, Tanaka S (2018) Does posterior scoliosis correction improve respiratory function in adolescent idiopathic scoliosis? A systematic review and meta-analysis. Glob Spine J 9:866\u2013873. https:\/\/doi.org\/10.1177\/2192568218811312","journal-title":"Glob Spine J"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-023-07615-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-023-07615-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-023-07615-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T06:05:06Z","timestamp":1685599506000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-023-07615-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["7615"],"URL":"https:\/\/doi.org\/10.1007\/s00586-023-07615-6","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]},"assertion":[{"value":"21 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"As it is a retrospective study and data was reviewed retrospectively from chart review, so patient\u2019s consents are waived with the approval of the Institutional Review Board.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}