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Thoracic pedicle screws have become the spinal anchor of choice because of the superior biomechanics of this technique. It is widely used for the treatment of scoliosis, spinal deformity (such as kyphosis), trauma, tumors, infection, and other pathologies. The technique demands precision as malposition can result in spinal cord or visceral injury with potential catastrophic consequences (death or paralysis).

There have been many published articles looking at the anatomy and the anatomic variation in various populations according to race, age, deformity, etc. Lenke and others have developed start point guidelines that seem to have reasonable validity.

There are two basic screw trajectories:

The straightforward technique.

The anatomic trajectory.

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