
The study investigated the risk factors associated with the misplacement of freehand pedicle screws during posterior approach surgery for degenerative scoliosis. A total of 204 patients were retrospectively analyzed, with 2496 screws placed, achieving a 95.07% accuracy rate. The overall misplacement rate was 4.93%, with higher rates observed in thoracic screws (11.11%) compared to lumbar screws (3.22%). Factors such as body mass index (BMI), Hu value, number of screw segments, Cobb angle, and vertebral rotation grade were identified as independent risk factors for screw misplacement (p < 0.05). Notably, the height of the posterior superior iliac spine significantly impacted screw placement in the lower lumbar spine (p < 0.05). Preoperative imaging assessments, including X-ray and 3D CT, are recommended to mitigate screw misplacement in degenerative scoliosis patients.
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