Thoracolumbar Instrumentation Options: Biomechanical Implications.
Rawall, Saurabh S; Hiatt, Luke A LA; Theiss, Steven S; et al.
This review discusses practical choices for pedicle screw-rod constructs, highlighting screw geometry (large outer diameter, conical inner diameter with V-threads, dual-core/dual-thread) and placement techniques (undertapping/no tapping, convergent trajectory) to optimize fixation, especially in osteoporotic bone. It reviews alternative fixation (cortical bone trajectory screws, sublaminar bands), cement augmentation strategies (fenestrated screws, biodegradable cements, HA-coated/expandable screws), rod materials and configurations, and preventive measures for proximal junctional kyphosis such as soft landing and vertebroplasty.