The pedicle screw (PS) system has been widely used for the spinal reconstruction. Even for the osteoporotic spine, PS system has been the first choice for the instrumentation. However, the usage of PS in the porotic spine seems to be challenging. When the PS is inserted in the osteoporotic vertebrae, the PS is sometimes loosened; eventually, it shows back out, because the PS cannot hold bones with osteoporosis efficiently [1,2].

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