Accuracy and Safety of a Triad-Dependent Technique for Subaxial Cervical Pedicle Screw Placement: A Prospective Cohort Study
Abstract
Study Design Prospective single-arm cohort study. Objectives Cervical pedicle screws (CPS) offer superior biomechanical stability compared with lateral mass screws. However, their widespread adoption is constrained by narrow pedicle safety margins and the potential risk of neurovascular injury. This study aimed to describe the rationale of a novel triad-dependent technique (TDT) for subaxial CPS placement and to evaluate its accuracy and safety. Methods Between May 2023 and April 2025, 63 consecutive patients undergoing posterior subaxial (C3–C6) cervical instrumentation at our institution were screened for eligibility. CPS were inserted using the TDT, which integrates individualized morphometric preoperative planning, intraoperative fluoroscopic guidance, and continuous tactile monitoring via mini-laminotomy. Postoperative CT was used to assess screw accuracy using the 2-mm breach classification. Multinomial logistic regression was performed to identify risk factors for breach. Results A total of 204 CPS were inserted in 41 patients. No breach was observed in 174 screws (85.3%), while 30 screws (14.7%) demonstrated breach, including 18 medial and 12 lateral violations. No neurovascular complications were observed in this cohort. Pedicle diameter <4 mm significantly increased the risk of both medial and lateral breach, while medial wall thickness showed direction-specific effects on breach risk. Conclusions The TDT demonstrates the feasibility of accurate and safe subaxial CPS placement. By integrating individualized morphometric planning with fluoroscopic and tactile safeguards, TDT effectively mitigates both medial and lateral breach risks and may expand the safe application of CPS fixation.
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BibTeX
@article{elmeshtawy2026accuracy,
title = {{Accuracy and Safety of a Triad-Dependent Technique for Subaxial Cervical Pedicle Screw Placement: A Prospective Cohort Study}},
author = {Mohamed El-Meshtawy MD and Mahmoud Abdelrahman Saleh MSc and Mariam A. Ibrahim PT, PhD and Belal Elnady MD and Mahmoud Fouad Ibrahim MD},
journal = {Global Spine Journal},
year = {2026},
month = oct,
doi = {10.1177/21925682261454294},
url = {https://doi.org/10.1177/21925682261454294},
note = {CC BY},
}
RIS
TY - JOUR
TI - Accuracy and Safety of a Triad-Dependent Technique for Subaxial Cervical Pedicle Screw Placement: A Prospective Cohort Study
AU - Mohamed El-Meshtawy MD
AU - Mahmoud Abdelrahman Saleh MSc
AU - Mariam A. Ibrahim PT, PhD
AU - Belal Elnady MD
AU - Mahmoud Fouad Ibrahim MD
PY - 2026
DA - 2026/10/31
JO - Global Spine Journal
DO - 10.1177/21925682261454294
UR - https://doi.org/10.1177/21925682261454294
AB - Study Design Prospective single-arm cohort study. Objectives Cervical pedicle screws (CPS) offer superior biomechanical stability compared with lateral mass screws. However, their widespread adoption is constrained by narrow pedicle safety margins and the potential risk of neurovascular injury. This study aimed to describe the rationale of a novel triad-dependent technique (TDT) for subaxial CPS placement and to evaluate its accuracy and safety. Methods Between May 2023 and April 2025, 63 consecutive patients undergoing posterior subaxial (C3–C6) cervical instrumentation at our institution were screened for eligibility. CPS were inserted using the TDT, which integrates individualized morphometric preoperative planning, intraoperative fluoroscopic guidance, and continuous tactile monitoring via mini-laminotomy. Postoperative CT was used to assess screw accuracy using the 2-mm breach classification. Multinomial logistic regression was performed to identify risk factors for breach. Results A total of 204 CPS were inserted in 41 patients. No breach was observed in 174 screws (85.3%), while 30 screws (14.7%) demonstrated breach, including 18 medial and 12 lateral violations. No neurovascular complications were observed in this cohort. Pedicle diameter <4 mm significantly increased the risk of both medial and lateral breach, while medial wall thickness showed direction-specific effects on breach risk. Conclusions The TDT demonstrates the feasibility of accurate and safe subaxial CPS placement. By integrating individualized morphometric planning with fluoroscopic and tactile safeguards, TDT effectively mitigates both medial and lateral breach risks and may expand the safe application of CPS fixation.
SN - 2192-5682
SN - 2192-5690
ER -