{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:54:25Z","timestamp":1791003265038,"version":"4.1.0"},"reference-count":31,"publisher":"Japanese Society for Spine Surgery and Related Research","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Spine Surg Relat Res"],"published-print":{"date-parts":[[2026,9,27]]},"DOI":"10.22603\/ssrr.2026-0004","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:11:08Z","timestamp":1776723068000},"page":"751-760","source":"Crossref","is-referenced-by-count":0,"title":["S1 Dual Outer Diameter Screws Accelerate Early Fusion Compared with Conventional Pedicle Screws in Posterior Lumbosacral Interbody Fusion"],"prefix":"10.22603","volume":"10","author":[{"given":"Hiroaki","family":"Onuma","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"},{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Hirai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fujiki","family":"Numano","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Tomori","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyohei","family":"Sakaki","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Matsukura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Egawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motonori","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshitaka","family":"Yoshii","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Institute of Science Tokyo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyasu","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"9891","reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"1. Xu F, Zhou S, Zou D, et al. The relationship between S1 screw loosening and postoperative outcome in patients with degenerative lumbar scoliosis. BMC Musculoskelet Disord. 2022;23 (1):186.","DOI":"10.1186\/s12891-022-05107-0"},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. Leong JC, Lu WW, Zheng Y, et al. Comparison of the strengths of lumbosacral fixation achieved with techniques using one and two triangulated sacral screws. Spine. 1998;23 (21):2289-94.","DOI":"10.1097\/00007632-199811010-00008"},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. McLachlin SD, Al Saleh K, Gurr KR, et al. Comparative assessment of sacral screw loosening augmented with PMMA versus a calcium triglyceride bone cement. Spine. 2011;36 (11):E699-704.","DOI":"10.1097\/BRS.0b013e3181fb73ea"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Mirkovic S, Abitbol JJ, Steinman J, et al. Anatomic consideration for sacral screw placement. Spine. 1991;16 (6) (suppl):S289-94.","DOI":"10.1097\/00007632-199106001-00022"},{"key":"5","doi-asserted-by":"crossref","unstructured":"5. Stovall DO, Jr., Goodrich JA, Lundy D, et al. Sacral fixation technique in lumbosacral fusion. Spine. 1997;22 (1):32-7.","DOI":"10.1097\/00007632-199701010-00006"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Finger T, Bayerl S, Onken J, et al. Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease. Eur Spine J. 2014;23 (5):1013-20.","DOI":"10.1007\/s00586-014-3165-6"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Pihlaj\u00e4maki H, Myllynen P, B\u00f6stman O. Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg Br. 1997;79 (2):183-9.","DOI":"10.1302\/0301-620X.79B2.0790183"},{"key":"8","doi-asserted-by":"crossref","unstructured":"8. Gu GN, Liu T, Ding J, et al. Comparison of three sacral screw internal fixation techniques in the treatment of L4-S1 lumbar degenerative disease with osteoporosis: a retrospective observational study. J Orthop Surg Res. 2024;19 (1):773.","DOI":"10.1186\/s13018-024-05281-y"},{"key":"9","doi-asserted-by":"crossref","unstructured":"9. Shima K, Fujibayashi S, Otsuki B, et al. S2 alar screw insertion accuracy and factors associated with screw loosening and lumbosacral nonunion. World Neurosurg. 2024;184:e129-36.","DOI":"10.1016\/j.wneu.2024.01.071"},{"key":"10","doi-asserted-by":"crossref","unstructured":"10. Lehman RA Jr, Kuklo TR, Belmont PJ Jr, et al. Advantage of pedicle screw fixation directed into the apex of the sacral promontory over bicortical fixation: a biomechanical analysis. Spine. 2002;27 (8):806-11.","DOI":"10.1097\/00007632-200204150-00006"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Orita S, Ohtori S, Eguchi Y, et al. Radiographic evaluation of monocortical versus tricortical purchase approaches in lumbosacral fixation with sacral pedicle screws: a prospective study of ninety consecutive patients. Spine. 2010;35 (22):E1230-7.","DOI":"10.1097\/BRS.0b013e3181e5092c"},{"key":"12","doi-asserted-by":"crossref","unstructured":"12. Luk KDK, Chen L, Lu WW. A stronger bicortical sacral pedicle screw fixation through the s1 endplate: an in vitro cyclic loading and pull-out force evaluation. Spine. 2005;30 (5):525-9.","DOI":"10.1097\/01.brs.0000154649.55589.bf"},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Matsukawa K, Kato T, Fujiyoshi K, et al. Radiological comparison of penetrating endplate trajectory versus anterior bicortical trajectory for sacral pedicle screw insertion in posterior lumbosacral interbody fusion. J Orthop Sci. 2022;27 (6):1203-7.","DOI":"10.1016\/j.jos.2021.07.026"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech. 2010;23 (6):404-9.","DOI":"10.1097\/BSD.0b013e3181b63f4d"},{"key":"15","doi-asserted-by":"crossref","unstructured":"15. Ergur I, Akcali O, Kiray A, et al. Neurovascular risks of sacral screws with bicortical purchase: an anatomical study. Eur Spine J. 2007;16 (9):1519-23.","DOI":"10.1007\/s00586-007-0326-x"},{"key":"16","doi-asserted-by":"crossref","unstructured":"16. Schreiber JJ, Anderson PA, Rosas HG, et al. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93 (11):1057-63.","DOI":"10.2106\/JBJS.J.00160"},{"key":"17","doi-asserted-by":"crossref","unstructured":"17. Zou D, Sun Z, Zhou S, et al. Hounsfield units value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases. Eur Spine J. 2020;29 (5):1105-11.","DOI":"10.1007\/s00586-020-06386-8"},{"key":"18","doi-asserted-by":"crossref","unstructured":"18. Duits AAA, van Urk PR, Lehr AM, et al. Radiologic assessment of interbody fusion: a systematic review on the use, reliability, and accuracy of current fusion criteria. JBJS Rev. 2024;12 (1):e23.","DOI":"10.2106\/JBJS.RVW.23.00065"},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine. 1995;20 (12):1410-8.","DOI":"10.1097\/00007632-199506020-00014"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine. 1994;19 (21):2415-20.","DOI":"10.1097\/00007632-199411000-00008"},{"key":"21","doi-asserted-by":"crossref","unstructured":"21. Christodoulou E, Chinthakunta S, Reddy D, et al. Axial pullout strength comparison of different screw designs: fenestrated screw, dual outer diameter screw and standard pedicle screw. Scoliosis. 2015;10:15.","DOI":"10.1186\/s13013-015-0039-6"},{"key":"22","doi-asserted-by":"crossref","unstructured":"22. Lorenz A, Leichtle CI, Frantz S, et al. Pull out strength of dual outer diameter pedicle screws compared to uncemented and cemented standard pedicle screws: a biomechanical in vitro study. Orthop Surg. 2017;9 (2):229-36.","DOI":"10.1111\/os.12322"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Wang DF, Chen XL, Han D, et al. The effect of sagittal alignment, coronal balance, and segmental stability on preoperative patient-reported outcomes in patients with degenerative lumbar spondylolisthesis. BMC Surg. 2023;23 (1):48.","DOI":"10.1186\/s12893-023-01947-2"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Thornley P, Urquhart JC, Glennie A, et al. Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery. Spine J. 2023;23 (10):1512-21.","DOI":"10.1016\/j.spinee.2023.06.004"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Bokov A, Bulkin A, Aleynik A, et al. Pedicle screws loosening in patients with degenerative diseases of the lumbar spine: potential risk factors and relative contribution. Glob Spine J. 2019;9 (1):55-61.","DOI":"10.1177\/2192568218772302"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Elder BD, Ishida W, Lo SL, et al. Use of S2-alar-iliac screws associated with less complications than iliac screws in adult Lumbosacropelvic fixation. Spine. 2017;42 (3):E142-9.","DOI":"10.1097\/BRS.0000000000001722"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine. 2013;38 (7):597-608.","DOI":"10.1097\/BRS.0b013e318273a2ea"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Zhang Y, Vengsarkar VA, Chi J, et al. L4-S1 ALIF restores and maintains lordosis while minimizing adjacent segment disease compared to L4-S1 TLIF. Spine J. 2025;26 (2):292-300.","DOI":"10.1016\/j.spinee.2025.06.001"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Hsieh PC, Koski TR, O'Shaughnessy BA, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine. 2007;7 (4):379-86.","DOI":"10.3171\/SPI-07\/10\/379"},{"key":"30","doi-asserted-by":"crossref","unstructured":"30. Singh M, Knebel A, Kuharski MJ, et al. One-level versus two-level anterior lumbar interbody fusion (ALIF) from L4 to S1 : comparison of complications, alignment, and patient outcomes. Spine. 2025;50 (4):271-6.","DOI":"10.1097\/BRS.0000000000005133"},{"key":"31","doi-asserted-by":"crossref","unstructured":"31. Oba H, Takahashi J, Ohba T, et al. Authors' response to letter to the editor. Fake union. Spine Surg Relat Res. 2023;7 (3):295-6.","DOI":"10.22603\/ssrr.2022-0214"}],"container-title":["Spine Surgery and Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/ssrr\/10\/5\/10_2026-0004\/_pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:39:48Z","timestamp":1791002388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/ssrr\/10\/5\/10_2026-0004\/_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,27]]},"references-count":31,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.22603\/ssrr.2026-0004","relation":{},"ISSN":["2432-261X"],"issn-type":[{"value":"2432-261X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,27]]},"article-number":"2026-0004"}}