{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:26:45Z","timestamp":1787776005297,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pedicle screw instrumentation has many advantages for correction of adolescent idiopathic scoliosis (AIS) deformity including better correction and fewer late complications. On the other hand, screw insertion in AIS is challenging. Intraoperative fluoroscopy or navigation techniques are expensive, time-consuming, and exposed to high radiation. Free-hand technique relies on the surgeon's experience and locating the pedicle entry point with anatomical landmarks. There are few studies that evaluated pedicle screw position accuracy with postoperative multi-slice computed tomography scan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We prospectively considered 38 consecutive AIS cases, who underwent corrective surgery with all pedicle screw technique. All the screws were inserted with free-hand technique using anatomic landmarks as a guide for an entry site. We divided pedicle penetration in medial, lateral, inferior, superior, and anterior vertebral body as Grades 0\u20134, that Grade 0 is fully contained within the pedicle, Grade 1 (&lt;2 mm), Grade 2 (2.1\u20134 mm), Grade 3 (4.1\u20136 mm), and Grade 4 (&gt;6 mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 720 screws were inserted, of which 623 screws (86.5%) were perfect and 97 screws (13.5%) were misplaced. Of those which were misplaced, 39 screws (40.2%) were medial and 58 (59.8%) were lateral, which shows that the prevalence of lateral misplacement was more in comparison to medial misplacement. However, in all misplaced cases, the deviation of the screw was &lt;2 mm (Grade 1). There was no misplacement in the inferior and superior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pedicle screw insertion in AIS with the free-hand technique is a safe and reliable method.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/2277-9175.201331","type":"journal-article","created":{"date-parts":[[2017,3,8]],"date-time":"2017-03-08T04:49:32Z","timestamp":1488948572000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["Evaluating Accuracy of Free-hand Pedicle Screw Insertion in Adolescent Idiopathic Scoliosis Using Postoperative Multi-Slice Computed Tomography Scan"],"prefix":"10.4103","volume":"6","author":[{"given":"Mohammadreza","family":"Etemadifar","sequence":"first","affiliation":[{"name":"From the Department of Orthopedic and Spine Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammadhossein","family":"Jamalaldini","sequence":"additional","affiliation":[{"name":"From the Department of Orthopedic and Spine Surgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,3,1]]},"reference":[{"key":"R1-20250806","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/01.bsd.0000154448.90707.a8","article-title":"Accuracy and safety of thoracic pedicle screw placement in spinal deformities","volume":"18","author":"Smorgick","year":"2005","journal-title":"J Spinal Disord Tech"},{"key":"R2-20250806","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1007\/s00586-002-0415-9","article-title":"Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis","volume":"11","author":"Liljenqvist","year":"2002","journal-title":"Eur Spine J"},{"key":"R3-20250806","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/01.brs.0000197865.20803.d4","article-title":"Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis","volume":"31","author":"Kim","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"R4-20250806","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/BRS.0b013e31816f2865","article-title":"Rationale behind the current state-of-the-art treatment of scoliosis (in the pedicle screw era)","volume":"33","author":"Lenke","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"key":"R5-20250806","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01.BRS.0000109983.12113.9B","article-title":"Free hand pedicle screw placement in the thoracic spine: Is it safe?","volume":"29","author":"Kim","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"key":"R6-20250806","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1097\/00007632-199311000-00015","article-title":"Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members","volume":"18","author":"Esses","year":"1993","journal-title":"Spine (Phila Pa 1976)"},{"key":"R7-20250806","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3340\/jkns.2012.51.1.66","article-title":"Free hand pedicle screw placement in the thoracic spine without any radiographic guidance: Technical note, a cadaveric study","volume":"51","author":"Hyun","year":"2012","journal-title":"J Korean Neurosurg Soc"},{"key":"R8-20250806","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1097\/00007632-200207150-00015","article-title":"Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities","volume":"27","author":"Belmont","year":"2002","journal-title":"Spine (Phila Pa 1976)"},{"key":"R9-20250806","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/00007632-200109150-00022","article-title":"Thoracic pedicle screw fixation in spinal deformities: Are they really safe?","volume":"26","author":"Suk","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"R10-20250806","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1097\/00007632-199506020-00012","article-title":"Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis","volume":"20","author":"Suk","year":"1995","journal-title":"Spine (Phila Pa 1976)"},{"key":"R11-20250806","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/00007632-200003010-00013","article-title":"Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine","volume":"25","author":"Wiesner","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"R12-20250806","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1097\/00007632-199810150-00014","article-title":"Clinical relevance of accuracy of pedicle screw placement. 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