{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:45:35Z","timestamp":1768877135222,"version":"3.49.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Globus Medical Inc."}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>To compare screw strains adjacent to a simulated spinal osteotomy between segmental compression (SC) and cantilever bending (CB) to SC and CB performed over a construct-to-construct lateral accessory rod (\u201crail\u201d).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>10 PCF foam blocks were instrumented with 6 polyaxial pedicle screws, each with a linear strain gage. SC and CB were performed over a traditional construct (midline rods) or over a construct-to-construct lateral accessory rod. Real-time screw strains were collected and peak strains were reported and compared between corrective techniques.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Strains in screws closest to the osteotomy were significantly less during \u201crail\u201d compression compared to traditional SC. Maximum screw strains were significantly lower during \u201crail\u201d SC (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and CB (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) compared to traditional SC and CB, respectively. Total screw strain was more evenly distributed over all 6 screws during \u201crail\u201d compression and CB compared to traditional techniques, which concentrated strain at individual screws adjacent to the osteotomy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Performing SC and CB across an accessory construct-to-construct lateral (\u201crail\u201d) rod resulted in significantly lower strain on individual pedicle screws adjacent to a simulated spinal osteotomy compared to traditional SC and CB. As such, the \u201crail\u201d may lessen risk of screw pull-out and screw plow during maneuvers to correct spinal deformities. Future work focused on building upon this controlled study in cadaveric specimens will be important to validate these findings in more clinically relevant scenarios.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s43390-025-01079-y","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T07:11:02Z","timestamp":1743405062000},"page":"987-995","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Construct-construct \u201crail technique\u201d decreases screw strain during spinal deformity corrective maneuvers: a mechanical analysis"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-2813","authenticated-orcid":false,"given":"Alekos A.","family":"Theologis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"DePhillips","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathaniel A.","family":"Myers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Mahoney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon S.","family":"Bucklen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"issue":"8","key":"1079_CR1","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1007\/s00586-017-5071-1","volume":"26","author":"JS Smith","year":"2017","unstructured":"Smith JS, Shaffrey CI, Lafage R et al (2017) Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients. Eur Spine J 26(8):2128\u20132137","journal-title":"Eur Spine J"},{"issue":"1","key":"1079_CR2","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s10143-021-01559-5","volume":"45","author":"PP Girod","year":"2022","unstructured":"Girod PP, K\u00f6gl N, Molliqaj G, Lener S, Hartmann S, Thom\u00e9 C (2022) Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev 45(1):517\u2013524","journal-title":"Neurosurg Rev"},{"issue":"3","key":"1079_CR3","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1177\/2192568217699203","volume":"7","author":"C Saifi","year":"2017","unstructured":"Saifi C, Laratta JL, Petridis P, Shillingford JN, Lehman RA, Lenke LG (2017) Vertebral column resection for rigid spinal deformity. Glob Spine J 7(3):280\u2013290","journal-title":"Glob Spine J"},{"issue":"4","key":"1079_CR4","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s12178-011-9101-z","volume":"4","author":"CR Good","year":"2011","unstructured":"Good CR, Auerbach JD, O\u2019Leary PT, Schuler TC (2011) Adult spine deformity. Curr Rev Musculoskelet Med 4(4):159\u2013167","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"11","key":"1079_CR5","doi-asserted-by":"publisher","first-page":"3243","DOI":"10.1007\/s00586-021-06969-z","volume":"30","author":"LG Lenke","year":"2021","unstructured":"Lenke LG, Zuckerman SL, Cerpa M et al (2021) The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery. Eur Spine J 30(11):3243\u20133254","journal-title":"Eur Spine J"},{"issue":"10","key":"1079_CR6","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1016\/j.spinee.2018.02.001","volume":"18","author":"MG Fehlings","year":"2018","unstructured":"Fehlings MG, Kato S, Lenke LG et al (2018) Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J 18(10):1733\u20131740","journal-title":"Spine J"},{"issue":"21","key":"1079_CR7","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1097\/01.BRS.0000092063.63315.D5","volume":"28","author":"KW Chang","year":"2003","unstructured":"Chang KW (2003) Cantilever bending technique for treatment of large and rigid scoliosis. Spine (Phila Pa 1976) 28(21):2452\u20132458","journal-title":"Spine (Phila Pa 1976)"},{"issue":"14","key":"1079_CR8","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1097\/BRS.0b013e31824fffde","volume":"37","author":"JD Auerbach","year":"2012","unstructured":"Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37(14):1198\u20131210","journal-title":"Spine (Phila Pa 1976)"},{"issue":"Suppl 1","key":"1079_CR9","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1007\/s00590-014-1470-8","volume":"24","author":"C Barrey","year":"2014","unstructured":"Barrey C, Perrin G, Michel F, Vital JM, Obeid I (2014) Pedicle subtraction osteotomy in the lumbar spine: indications, technical aspects, results and complications. Eur J Orthop Surg Traumatol 24(Suppl 1):S21-30","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"1","key":"1079_CR10","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.3171\/foc.2003.14.1.3","volume":"14","author":"RP Schlenk","year":"2003","unstructured":"Schlenk RP, Kowalski RJ, Benzel EC (2003) Biomechanics of spinal deformity. Neurosurg Focus 14(1):e2","journal-title":"Neurosurg Focus"},{"issue":"2","key":"1079_CR11","first-page":"237","volume":"26","author":"AP Collins","year":"2024","unstructured":"Collins AP, Clark AJ, Ames CP, Theologis AA (2024) Proximal junctional fracture and kyphosis: correction with posterior vertebral column resection and the \u201cRail Technique\u201d: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 26(2):237","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"3","key":"1079_CR12","doi-asserted-by":"publisher","first-page":"652","DOI":"10.14245\/ns.2040390.195","volume":"17","author":"AA Theologis","year":"2020","unstructured":"Theologis AA, Gupta MC (2020) The \u201crail technique\u201d for correction of cervicothoracic kyphosis: case report and surgical technique description. Neurospine 17(3):652\u2013658","journal-title":"Neurospine"},{"issue":"21","key":"1079_CR13","doi-asserted-by":"publisher","first-page":"2755","DOI":"10.1097\/00007632-200011010-00007","volume":"25","author":"DA Spiegel","year":"2000","unstructured":"Spiegel DA, Cunningham BW, Oda I, Dormans JP, McAfee PC, Drummond DS (2000) Anterior vertebral screw strain with and without solid interspace support. Spine (Phila Pa 1976) 25(21):2755\u20132761","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"1079_CR14","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1097\/00007632-199602010-00006","volume":"21","author":"M Chiba","year":"1996","unstructured":"Chiba M, McLain RF, Yerby SA, Moseley TA, Smith TS, Benson DR (1996) Short-segment pedicle instrumentation. Biomechanical analysis of supplemental hook fixation. Spine (Phila Pa 1976) 21(3):288\u2013294","journal-title":"Spine (Phila Pa 1976)"},{"issue":"13","key":"1079_CR15","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.1097\/00007632-199707010-00006","volume":"22","author":"RF McLain","year":"1997","unstructured":"McLain RF, McKinley TO, Yerby SA, Smith TS, Sarigul-Klijn N (1997) The effect of bone quality on pedicle screw loading in axial instability. A synthetic model. Spine (Phila Pa 1976) 22(13):1454\u20131460","journal-title":"Spine (Phila Pa 1976)"},{"key":"1079_CR16","volume-title":"Standard specification for rigid polyurethane foam for use as a standard material for testing orthopaedic devices and instruments","author":"ASTM F1839-08","year":"2021","unstructured":"ASTM F1839-08 (2021) Standard specification for rigid polyurethane foam for use as a standard material for testing orthopaedic devices and instruments. ASTM"},{"issue":"15","key":"1079_CR17","doi-asserted-by":"publisher","first-page":"CASE2527","DOI":"10.3171\/CASE22527","volume":"5","author":"JM Sarmiento","year":"2023","unstructured":"Sarmiento JM, Fourman MS, Kim HJ (2023) Construct-to-construct biplanar cantilever technique for spinal deformity correction: illustrative case. J Neurosurg Case Lessons 5(15):CASE2527","journal-title":"J Neurosurg Case Lessons"},{"issue":"9","key":"1079_CR18","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/j.spinee.2020.04.021","volume":"20","author":"DH Kim","year":"2020","unstructured":"Kim DH, Hwang RW, Lee GH et al (2020) Comparing rates of early pedicle screw loosening in posterolateral lumbar fusion with and without transforaminal lumbar interbody fusion. Spine J 20(9):1438\u20131445","journal-title":"Spine J"},{"issue":"5","key":"1079_CR19","doi-asserted-by":"publisher","first-page":"716","DOI":"10.3171\/2019.11.SPINE19868","volume":"32","author":"D Zou","year":"2020","unstructured":"Zou D, Muheremu A, Sun Z, Zhong W, Jiang S, Li W (2020) Computed tomography Hounsfield unit-based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine 32(5):716\u2013721","journal-title":"J Neurosurg Spine"},{"issue":"9","key":"1079_CR20","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1748-7161-9-13","volume":"24","author":"K Abul-Kasim","year":"2014","unstructured":"Abul-Kasim K, Ohlin A (2014) Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis: a 2 year follow-up with low-dose CT. Scoliosis 24(9):13","journal-title":"Scoliosis"},{"issue":"8","key":"1079_CR21","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00402-016-2487-8","volume":"136","author":"J Bredow","year":"2016","unstructured":"Bredow J, Boese CK, Werner CM et al (2016) Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg 136(8):1063\u20131067","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"1079_CR22","doi-asserted-by":"publisher","first-page":"3595","DOI":"10.1038\/s41598-021-83251-8","volume":"11","author":"L La Barbera","year":"2021","unstructured":"La Barbera L, Wilke HJ, Ruspi ML et al (2021) Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy. Sci Rep 11(1):3595","journal-title":"Sci Rep"},{"issue":"7","key":"1079_CR23","doi-asserted-by":"publisher","first-page":"E388","DOI":"10.1097\/BRS.0000000000001282","volume":"41","author":"DW Hallager","year":"2016","unstructured":"Hallager DW, Gehrchen M, Dahl B et al (2016) Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study. Spine (Phila Pa 1976) 41(7):E388\u2013E395","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"1079_CR24","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s43390-022-00627-0","volume":"11","author":"N Shekouhi","year":"2023","unstructured":"Shekouhi N, Vosoughi AS, Goel VK, Theologis AA (2023) Does number of rods matter? 4-, 5-, and 6-rods across a lumbar pedicle subtraction osteotomy: a finite element analysis. Spine Deform 11(3):535\u2013543","journal-title":"Spine Deform"},{"issue":"1","key":"1079_CR25","doi-asserted-by":"publisher","first-page":"12510","DOI":"10.1038\/s41598-021-91952-3","volume":"11","author":"X Feng","year":"2021","unstructured":"Feng X, Qi W, Zhang T et al (2021) Lateral migration resistance of screw is essential in evaluating bone screw stability of plate fixation. Sci Rep 11(1):12510","journal-title":"Sci Rep"},{"issue":"6","key":"1079_CR26","doi-asserted-by":"publisher","first-page":"660","DOI":"10.3390\/bioengineering10060660","volume":"10","author":"LC Wu","year":"2023","unstructured":"Wu LC, Hsieh YY, Tsuang FY, Kuo YJ, Chen CH, Chiang CJ (2023) Pullout strength of pedicle screws inserted using three different techniques: a biomechanical study on polyurethane foam block. Bioengineering (Basel) 10(6):660","journal-title":"Bioengineering (Basel)"},{"issue":"4","key":"1079_CR27","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jspd.2015.12.008","volume":"4","author":"F Amirouche","year":"2016","unstructured":"Amirouche F, Solitro GF, Magnan BP (2016) Stability and spine pedicle screws fixation strength\u2014a comparative study of bone density and insertion angle. Spine Deform 4(4):261\u2013267","journal-title":"Spine Deform"},{"issue":"1","key":"1079_CR28","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jspd.2012.07.004","volume":"1","author":"LE Hickerson","year":"2013","unstructured":"Hickerson LE, Owen JR, Wayne JS, Tuten HR (2013) Calcium triglyceride versus polymethylmethacrylate augmentation: a biomechanical analysis of pullout strength. Spine Deform 1(1):10\u201315","journal-title":"Spine Deform"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-025-01079-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-025-01079-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-025-01079-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T18:04:30Z","timestamp":1751652270000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-025-01079-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["1079"],"URL":"https:\/\/doi.org\/10.1007\/s43390-025-01079-y","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]},"assertion":[{"value":"20 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None relevant to the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}