SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1607323
This article is part of the Research TopicNew Perspectives and Innovative Techniques in Contemporary Spine Surgery - Volume IIView all 10 articles
Low density pedicle screw in adolescent idiopathic scoliosis: A systematic review and meta-analysis of 1762 patients
Provisionally accepted
- 1Peking University People's Hospital, Beijing, China
- 2AVIC 363 Hospital, Chengdu, Sichuan Province, China
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High-density pedicle screws provide satisfactory correction in Adolescent idiopathic scoliosis (AIS) but add to the operative time, blood loss, and cost; low-density constructs may mitigate these burdens and achieve similar correction results. Studies use inconsistent density cutoffs (most often <1.6 screws/level) and report conflicting results; therefore, we performed a systematic review and meta-analysis to clarify the clinical, radiographic, and economic impact of low screw density in AIS patients.A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Web of Science, and Embase databases were searched until December 2024 for comparative studies. The outcomes analyzed included surgical and safety parameters (blood loss, operative time, revision rates, and complications), radiographic outcomes (Cobb angle, correction rate, and thoracic kyphosis), and implant costs. Statistical analyses were performed using RevMan 5.4, with fixed-or random-effects models applied on the basis of heterogeneity (I² threshold<50%).Twenty-one studies comprising 1762 patients met the inclusion criteria.Low-density screws were superior in reducing blood loss (MD = -88.06, P = 0.01) and operative time (MD: -22.27, P=0.02), with no significant difference in revision rates (P=0.78) or complications (P=0.64). No differences were observed between the groups in the final Cobb angle (P=0.4), Cobb correction rate (P=0.21), or thoracic kyphosis (P=0.43). The per-level implant cost was lower (SMD: -1.32, P<0.00001) in the low-density group.Compared with high-density screws, low-density pedicle screws provide comparable radiographic and safety outcomes while reducing the operative time, blood loss, and cost. These findings support the use of low-density constructs in AIS surgery, although the variability in study designs and screw density definitions warrants further research. Future multicenter randomized controlled trials are needed to refine the optimal screw density strategies for treating AIS.
Keywords: Adolescent idiopathic scoliosis, Screw density, high density, Low density, Deformity
Received: 07 Apr 2025; Accepted: 10 Jul 2025.
Copyright: © 2025 Zheng, Zhou, Liu and Qiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhe Qiang, AVIC 363 Hospital, Chengdu, Sichuan Province, China
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