{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T23:17:34Z","timestamp":1783207054294,"version":"3.54.6"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Experimental ex vivo biomechanical cadaver study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Thoracic pedicle screws are essential for stabilizing spinal injuries, but misplacement remains a frequent complication. While many studies focus on neurovascular injuries, the impact of the degree of lateral misplacement (offset) on the biomechanical stability of thoracic pedicle screws has not been examined. Therefore, this study aimed to evaluate the influence of lateral offset on pullout force (POF) and peak insertion torque (PIT), and to analyse additional factors such as screw diameter, screw length, and bone quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this ex vivo cadaveric study, 61 thoracic vertebrae (T1\u2013T12) from seven human cadavers were instrumented using pedicle screws placed with predefined lateral offsets via 3D-printed templates. Each vertebra received one optimal and one offset screw for pairwise comparison. Biomechanical testing included cyclic loading followed by axial pullout testing. Linear mixed-effects models assessed the influence of offset, screw diameter, screw length, and bone density on POF and PIT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lateral offset significantly reduced POF and PIT. Each millimeter of offset decreased POF by 41.1 N (\u22129.2%;\n                      <jats:italic toggle=\"yes\">p&lt;0.001<\/jats:italic>\n                      ) and PIT by 0.079 Nm (\u22125.9%;\n                      <jats:italic toggle=\"yes\">p=0.002<\/jats:italic>\n                      ). Larger screw diameter significantly increased both POF and PIT (\n                      <jats:italic toggle=\"yes\">p=0.020; p&lt;0.001<\/jats:italic>\n                      ). Screw length and bone quality showed no significant independent effects. POF and PIT were strongly correlated (r=0.637,\n                      <jats:italic toggle=\"yes\">p&lt;0.001<\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lateral offset significantly reduced both pullout force and peak insertion torque of thoracic pedicle screws, demonstrating a progressive loss of biomechanical stability with increasing misplacement. These findings underline the biomechanical relevance of accurate thoracic pedicle screw placement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261464143","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:03:21Z","timestamp":1782907401000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of Lateral Perforation on the Biomechanical Stability of Thoracic Pedicle Screws"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3539-4839","authenticated-orcid":false,"given":"Benno","family":"Bullert","sequence":"first","affiliation":[{"name":"BG Klinik Ludwigshafen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Gupta","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mareike","family":"Schonhoff","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Jaeger","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Philippe","family":"Kretzer","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gruetzner","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8024-9276","authenticated-orcid":false,"given":"Sven Y.","family":"Vetter","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3955-0339","authenticated-orcid":false,"given":"Jula","family":"Gierse","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-008-1524-7"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198707000-00007"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-008-1538-1"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2015.1019414"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199001000-00004"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-020-02673-7"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.02.217"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-008-1539-0"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.7.FOCUS11168"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199411000-00008"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199111000-00015"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002305"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5025-7"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-012-0900-1"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-021-06739-x"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13237017"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001"},{"issue":"3","key":"e_1_3_7_19_2","first-page":"E133","article-title":"Biomechanical evaluation of the pedicle screw insertion depth effect on screw stability under cyclic loading and subsequent pullout","volume":"28","author":"Karami KJ","year":"2015","unstructured":"Karami KJ, Buckenmeyer LE, Kiapour AM, et al. Biomechanical evaluation of the pedicle screw insertion depth effect on screw stability under cyclic loading and subsequent pullout. Clinical Spine Surgery. 2015;28(3):E133-E139.","journal-title":"Clinical Spine Surgery"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13013-015-0039-6"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2023.101780"},{"issue":"1","key":"e_1_3_7_22_2","first-page":"219256822513435","article-title":"Analysis of Screw\/Pedicle-Width Ratio and Accuracy in Navigated Versus 3D-Controlled Fluoroscopy-Guided Pedicle Screw Placement","volume":"16","author":"Gierse J","year":"2025","unstructured":"Gierse J, Zimmermann F, Gr\u00fctzner PA, Stallkamp J, Vetter SY, Mandelka E. Analysis of Screw\/Pedicle-Width Ratio and Accuracy in Navigated Versus 3D-Controlled Fluoroscopy-Guided Pedicle Screw Placement. Global Spine J. 2025;16(1):21925682251343523.","journal-title":"Global Spine J"},{"issue":"4","key":"e_1_3_7_23_2","first-page":"325","article-title":"Thoracic pedicle screws: postoperative computerized tomography scanning assessment","volume":"100","author":"Heary RF","year":"2004","unstructured":"Heary RF, Bono CM, Black M. Thoracic pedicle screws: postoperative computerized tomography scanning assessment. Journal of neurosurgery. 2004;100(4 Suppl Spine):325-331.","journal-title":"Journal of neurosurgery"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004398"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.3171\/2009.11.SPINE09408"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.03.046"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-015-0157-0"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.09.008"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200009150-00005"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200111010-00010"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200207150-00015"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-004-1422-9"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000083280.72978.D1"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000350869.35779.05"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199711010-00007"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000151"},{"key":"e_1_3_7_37_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.2796022"},{"key":"e_1_3_7_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199309000-00016"},{"key":"e_1_3_7_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2004.02.006"},{"key":"e_1_3_7_40_2","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2346830.415"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001738"},{"key":"e_1_3_7_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000164257.69354.bb"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261464143","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682261464143","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261464143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T22:46:24Z","timestamp":1783205184000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682261464143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":41,"alternative-id":["10.1177\/21925682261464143"],"URL":"https:\/\/doi.org\/10.1177\/21925682261464143","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"21925682261464143"}}