Search Results (6,607)

Background/Objectives: Right vertical infra-axillary thoracotomy to repair ventricular septal defects (VSDs) and atrial septal defects (ASDs) is less invasive than conventional surgical repair via median sternotomy. However, right vertical infra-axillary thoracotomy (RVIAT) may result in unilateral lung injury, a serious postoperative complication requiring extracorporeal circulation and unilateral lung collapse. The aim of this study was to evaluate whether repeated lung recruitment provides enhanced respiratory compliance and lung oxygenation in children who have undergone right vertical infra-axillary thoracotomy (RVIAT) to correct a congenital heart defect. Methods: Eligible participants were children with a common congenital heart defect corrected via RVIAT. Seventy-seven children were randomly classified into two groups. In group A (n = 39), an alveolar recruitment maneuver (ARM) was performed immediately after cardiopulmonary bypass. Children in group C (n = 38) did not receive any additional interventions during surgery. Results: The ARM group tolerated open lung ventilation without significant hemodynamic instability. Compared to controls, intraoperative PaO₂, PaO₂/FiO₂ and lung compliance (Com_dyn) improved in group A (p < 0.05), who also showed a significantly lower IL-6 (p < 0.05). In addition, group A had a lower incidence of lung injury and lung atelectasis than Group C at specific post CPB time points. Conclusions: Our findings provide some indication that the application of ARM could effectively improve the oxygenation profile, reduce postoperative pulmonary complications, and attenuate the postoperative inflammatory response in children with a common congenital heart defect corrected via the RVIAT technique. Full article

Background/Objectives: Ureteral complications following oblique lumbar interbody fusion (OLIF) are uncommon and are typically attributed to direct mechanical injury. Functional ureteral obstruction without overt ureteral damage remains poorly characterized. We report two cases that provide clinical and intraoperative evidence of a previously underrecognized mechanism of ureteral obstruction associated with anterior cage positioning during OLIF. Case Presentation: Among 180 OLIF procedures performed by a single surgeon, two cases (1.1%) of postoperative or intraoperative ureteral compromise without direct structural injury were identified. In the first case, postoperative imaging revealed hydronephrosis and focal angulation of the left proximal ureter at the level of the interbody cage, without contrast extravasation. The obstruction was managed with double-J ureteral stenting, and serial renal function monitoring confirmed preserved renal function throughout the clinical course. In the second case, retroperitoneal tissue including the ureter was directly observed intraoperatively to be interposed between the anterior longitudinal ligament and the interbody cage during anterior cage placement. Release of the interposed tissue resulted in immediate ureteral decompression without structural damage. Correlation of the postoperative findings in the first case with the intraoperative observations of the second case supports a unified mechanistic explanation: anterior cage advancement may draw retroperitoneal tissue into the cage–anterior longitudinal ligament interface, subjecting the ureter to focal compression or angulation. Conclusions: Functional ureteral obstruction during OLIF may occur secondary to retroperitoneal tissue interposition rather than direct ureteral trauma. Awareness of this mechanism and meticulous protection of the anterior retroperitoneal layer during cage advancement may help prevent avoidable ureteral complications. Full article

Background/Objectives: Adenomyosis is a common disorder of the uterus in those of reproductive age. Robotic-assisted surgery has been adopted to address the technical challenges of adenomyomectomy. This systematic review evaluated the current evidence regarding the feasibility, safety, and clinical outcomes of robotic-assisted conservative surgery for uterine adenomyosis. Methods: A systematic review of literature was performed on five databases, from the beginning to 21 December 2025, to identify studies reporting robotic-assisted uterus-sparing surgical approaches to adenomyosis. Data were collected on patient characteristics, surgical techniques used, pre- and post-operative pain, fertility outcomes, and complications. Risk of bias was evaluated using the ROBINS-I framework. Results: A total of 514 articles were found; six studies met the inclusion criteria. Most included studies were small and retrospective. The operative time ranged from 279 to 147 min. Mean blood loss ranged between 25 and 296 mL with a low rate of conversion and perioperative complications. Dysmenorrhea improved after surgery as reflected by the post operative visual analog scale pain score and serum CA-125 level. Few reproductive data were collected about successive spontaneous pregnancies. Risk of bias was serious or moderate in all studies included. Conclusions: Robotic-assisted conservative surgery for adenomyosis may represent a feasible and safe option for women with symptomatic adenomyosis who wish preserve the uterus, with a positive impact on patients’ symptoms. Large prospective, multicenter studies with standardized protocols and long-term follow-up are needed to clarify the real impact of robotic surgery in adenomyosis management. Full article

Background: To evaluate the real-world safety and mid-term clinical performance of the Ankura™ AAA Stent Graft System in patients undergoing endovascular aneurysm repair (EVAR). Materials and Methods: This prospective, multicenter PMCF study analyzed 100 patients with abdominal aortic aneurysms (AAAs). Patients were monitored for a mean duration of 2.26 years. Primary endpoints included 30-day major adverse events and 24-month treatment success. Statistical evaluation of risk factors for reintervention was performed using univariate logistic regression. Results: The study cohort was predominantly male (97%), with a mean age of 72.01 years. Hypertension (90%) and smoking (89%) were the most prevalent comorbidities. Regarding the primary endpoints, the 30-day MAE rate was 2%. During the overall follow-up (mean 2.26 years), the primary patency rate was 97%, demonstrating high structural integrity and sustained patency. However, the overall freedom from reintervention rate was 74%, corresponding to a 26% reintervention requirement and a 27% incidence of endoleak. Reinterventions were almost exclusively driven by these post-procedural morphological complications; specifically, 26 of the 27 patients with endoleaks required a secondary procedure. No preoperative clinical or anatomical parameters were identified as significant independent predictors of reintervention in the univariate analysis (p > 0.05). The overall mortality rate was 12%, with 0% aneurysm-related mortality. Conclusions: Mid-term success and reintervention after EVAR with the Ankura™ system are primarily driven by postoperative morphological complications, such as endoleaks, rather than baseline patient risk profiles. These findings underscore the critical importance of rigorous, lifelong radiological surveillance regardless of preoperative anatomical challenges. Full article

Background: Rare appendicular pathologies (RAP) are uncommon clinical entities with important diagnostic and therapeutic implications. These conditions frequently mimic acute appendicitis, yet they may require different operative strategies and, in selected cases, oncological management. Methods: We performed a retrospective cohort study including all patients who underwent surgery with the intention of performing an appendectomy at the First Surgical Clinic, Emergency County University Hospital of Cluj-Napoca, between 2018 and 2021. During this interval, 330 appendectomies were performed. Patients with a histopathological diagnosis of RAP were included. Clinical, imaging, surgical, histopathological, postoperative, and follow-up data were analyzed, with particular attention to the preoperative diagnostic work-up and imaging-based suspicion of rare appendicular pathology. Results: Ten patients (3.03%) were diagnosed with RAP, including low-grade appendiceal mucinous neoplasm (LAMN; n = 5), mucinous cystadenoma (n = 2), appendiceal adenocarcinoma (n = 1), appendicular diverticulum (n = 1), and stump appendicitis (n = 1). Computed tomography was the main diagnostic modality, particularly in patients with atypical presentation or suspicion of complicated or neoplastic appendiceal disease, while magnetic resonance imaging and colonoscopy provided additional information in selected cases. Preoperative suspicion of a rare or neoplastic appendiceal pathology was achieved in 70% of patients. Laparoscopic appendectomy was performed in 6 patients, open appendectomy in 1 patient, open ileocecal resection in 1 patient, open right hemicolectomy in 1 patient, and laparoscopic right hemicolectomy in 1 patient. Histopathological examination confirmed the diagnosis in all cases. Immediate postoperative outcomes were favorable, without perioperative mortality or major complications; during follow-up, the patient with adenocarcinoma required oncological treatment and resection of a local recurrence 1 year after surgery. Conclusions: RAP represent a small but clinically significant subset of appendiceal disease. Structured preoperative imaging, intraoperative recognition of atypical findings, and an individualized surgical strategy are essential for optimal outcomes and appropriate oncological management. Full article

Background: Post-bariatric hypoglycemia (PBH) is a clinically significant complication of bariatric surgery, characterized by inappropriate postprandial hyperinsulinemia and recurrent hypoglycemia. Episodes are often frequent, severe, and medically refractory, substantially impacting quality of life and potentially causing compensatory carbohydrate intake that leads to weight regain. Methods: A 50-year-old male underwent Roux-en-Y gastric bypass (RYGB) in 2009. Symptomatic postprandial hypoglycemia emerged in the second postoperative year and progressively worsened to multiple severe daily episodes. The patient developed compensatory carbohydrate intake with subsequent weight regain. Following the failure of dietary interventions and pharmacologic therapy, he underwent conversion to single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) in September 2022. Results: Following surgical conversion, the patient reported no clinically significant hypoglycemia during the follow-up period. Weight and obesity-related comorbidities improved. Gastrointestinal symptoms remained manageable, and micronutrient status was closely monitored. Conclusions: In selected patients with severe, medically refractory PBH following RYGB, conversion to an ileal-based procedure may be considered a viable therapeutic strategy. Prospective studies are needed to better define this hypothesis. Full article

Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH₂O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Full article

Carcinomas of the pancreas and bile duct remain highly lethal malignancies, with surgical resection representing the only potentially curative treatment. Despite improvements in perioperative mortality, postoperative complications remain frequent and negatively affect long-term outcomes. Recent evidence suggests that the pancreas and bile ducts harbor distinct microbial communities, challenging the traditional concept of sterility in these environments. However, their composition and clinical relevance remain incompletely understood. This study aimed to characterize microbiome profiles across different anatomical sites in patients undergoing pancreatic surgery, evaluate the impact of preoperative biliary stenting, and assess associations between prevalent bacterial species and postoperative outcomes. A total of 224 samples (bile, pancreatic fluid, duodenal tissue, tumor tissue, and healthy pancreatic tissue) from 58 patients with pancreatic cancer, bile duct cancer, chronic pancreatitis, or healthy pancreas were analyzed using 16S rRNA gene sequencing. Microbial diversity was assessed using the Shannon index for alpha diversity and nMDS with PERMANOVA for beta diversity. Distinct microbial profiles were identified across body sites, with significant beta-diversity differences between duodenal, bile, and pancreatic fluid samples and between duodenal and pancreatic fluid samples from the same patient. Preoperative biliary stenting significantly influenced microbial composition. Enterococcus faecalis was associated with a reduced risk of severe postoperative complications (Clavien–Dindo ≥ III). Overall, microbial composition varies across anatomical sites and disease entities, and specific bacteria may influence surgical outcomes, warranting further investigation in larger cohorts. Full article

Background: Congenital muscular torticollis (CMT) is usually managed conservatively during infancy, whereas surgical treatment is considered for persistent deformity in older children. However, evidence remains limited regarding the outcomes of distal resection combined with proximal release of the sternocleidomastoid muscle in children presenting beyond infancy. This study aimed to evaluate the functional and cosmetic outcomes of this combined approach in patients aged 3 years and older. Methods: This retrospective single-surgeon series included 37 patients with CMT aged 3 to 14 years who underwent distal resection combined with proximal release of the sternocleidomastoid muscle between 2002 and 2024. Preoperative and postoperative assessments were performed using the clinical outcome framework originally described by Lee et al., goniometric measurement of cervical rotation and lateral flexion, and clinical evaluation of head tilt, facial asymmetry, scar appearance, lateral band formation, and sternocleidomastoid V-column contour. Patients were also analyzed according to age at surgery, as 3–10 years and 11–14 years. Results: The mean age at surgery was 4.7 years, and the mean follow-up duration was 3.4 years. Significant postoperative improvement was observed in all major functional outcomes. Mean cervical rotation improved from 54.2 ± 8.6° to 87.9 ± 3.4°, and mean lateral flexion improved from 24.1 ± 6.8° to 44.5 ± 3.2° (both p < 0.001). Preoperative functional assessment scores averaged 6.8 ± 1.4, whereas postoperative total outcome scores averaged 14.2 ± 0.9. At final follow-up, no patient had residual head tilt. Mild residual facial asymmetry persisted in 3 patients (8.1%). Overall, postoperative outcomes were rated as excellent in 33 patients (89.2%) and good in 4 patients (10.8%). A slight partial loss of the sternocleidomastoid V-column contour was observed in 34 patients (91.9%), although this finding was not documented as a major cosmetic concern in the available clinical records. Hypertrophic scarring developed in 1 patient (2.7%). No lateral band formation, recurrence, revision surgery, infection, or hematoma was observed. Conclusions: Distal resection combined with proximal release provided favorable functional and cosmetic outcomes in children older than 3 years with CMT. The technique was associated with marked improvement in cervical motion, correction of head tilt, low complication rates, and a high proportion of excellent or good results. Full article

Descemet stripping automated endothelial keratoplasty (DSAEK) is a well-established surgical technique for the treatment of endothelial dysfunction, in which intracameral gas tamponade plays a critical role in graft adherence. We report the case of a 67-year-old pseudophakic woman with advanced Fuchs endothelial corneal dystrophy and symptomatic pseudophakic bullous keratopathy in the right eye, who presented with progressive visual deterioration and underwent DSAEK using an 8.25 mm donor graft inserted with a Busin glide and tamponaded with a 25% sulfur hexafluoride (SF6) gas–air mixture. On the first postoperative day, slit-lamp examination suggested an appropriate anterior chamber configuration and satisfactory graft attachment. However, detailed multiplanar anterior segment optical coherence tomography (AS-OCT), defined here as assessment using vertical, horizontal, and rotational scan orientations, revealed subtle posterior migration of the gas bubble beneath the iris plane. This clinically occult finding indicated altered anterior segment anatomy associated with a risk of secondary angle-closure mechanisms and raised concern for malignant glaucoma. Prompt surgical re-intervention was undertaken on postoperative day one, involving decompression of the misdirected gas bubble and reinjection of a centrally positioned tamponade. This resulted in restoration of normal anterior chamber configuration and stable graft adherence. Best-corrected visual acuity (BCVA) improved from 0.1 Snellen (1.0 logMAR) preoperatively to 0.7 Snellen (0.15 logMAR) at 2 weeks following surgery. This case highlights the added value of multiplanar AS-OCT in detecting clinically occult posterior gas migration after DSAEK, particularly when the abnormality is scan-orientation-dependent and not apparent on slit-lamp examination, thereby enabling timely intervention in the presence of a potentially sight-threatening postoperative configuration. Full article

Background: Chronic reducible scapholunate instability (SLI) remains a challenging condition, with multiple surgical options described, often associated with soft tissue disruption and postoperative stiffness. We describe a mini-invasive dorsal capsulodesis technique aimed at restoring carpal alignment while minimizing surgical morbidity, and we report preliminary clinical and radiographic outcomes. Methods: This study includes a retrospective analysis of the first 10 consecutive patients treated with this technique who had a minimum follow-up of 3 years. All patients presented with chronic, reducible scapholunate instability. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Radiographic evaluation was performed to assess maintenance of scapholunate alignment and progression to degenerative changes. Results: At a mean follow-up of approximately 4 years, patients showed a substantial reduction in pain (mean VAS from 8 preoperatively to 2 postoperatively) and improvement in function (mean QuickDASH from 74.6 to 16.5). Radiographic evaluation demonstrated maintenance of carpal alignment in all cases, with no progression to scapholunate advanced collapse (SLAC) observed. Wrist range of motion improved postoperatively, with extension reaching approximately 80° and flexion 70°, without significant functional limitations. No major complications or reoperations were recorded. Patient satisfaction was high, with 9 patients reporting being extremely satisfied and 1 satisfied. Conclusions: This mini-invasive dorsal capsulodesis appears to be a feasible and tissue-sparing option for selected cases of chronic reducible scapholunate instability. In this preliminary series, the technique was associated with favorable clinical and radiographic outcomes at mid-term follow-up. Further studies with larger cohorts and comparative designs are needed to confirm these findings. Full article

Background: Postoperative anemia associated with intertrochanteric hip fracture is a detrimental complication that detrimentally impairs patients’ outcomes. This study is designed to develop an online predictive tool to assist physicians in developing surgical blood preparation strategies to prevent the occurrence of postoperative anemia. Methods: This study included data collected from June 2017 to June 2025 on intertrochanteric hip fracture patients at Tangdu Hospital, including demographic information, comorbidities, vital signs, and laboratory results. LASSO regression was used to select predictive variables, and seven machine learning techniques: Logistic Regression, Support Vector Machine, Decision Tree, LightGBM, XGBoost, Neural Networks, and Random Forest, were compared to identify the best tool for predicting postoperative anemia risk. We created a patient-specific risk prediction tool with SHAP-driven interpretability for clinical decision support. Results: A total of 815 patients were included in the analysis, of whom 208 (25.5%) presented with postoperative anemia. Eight variables were selected to build seven machine learning models. Among these, the SVM model exhibited the best predictive performance in terms of discrimination, calibration, and clinical applicability, with an AUC range of 0.827–0.831. In test sets encompassing diverse population characteristics, SVM achieved the highest sensitivity (72.73%), accuracy (77.78%), and F1 score (57.14%). Conclusions: We established an online prediction platform for clinical practice, enabling clinicians to assess anemia risk in intertrochanteric hip fracture patients and support early prevention of postoperative anemia. Full article

Objective: To explore the application value of indocyanine green lymphography (ICGL) in the treatment of microcystic lymphatic malformation (mLM). Methods: This study was a prospective, randomized controlled clinical trial. Children with mLM who presented between November 2023 and November 2025 were recruited as subjects. They were randomly assigned in a 1:1 ratio to two groups: experimental group (ICGL-guided partial resection of mLM + penetration sclerotherapy), or control group (conventional partial resection of mLM + penetration sclerotherapy). Clinical baseline data were recorded, including gender, age, lesion location, and maximum lesion diameter. The primary outcomes were efficacy-related parameters (cure rate, effective rate, and number of subsequent treatments). Secondary outcome measures included intraoperative and postoperative parameters (operative time, postoperative drainage, follow-up duration) and related complications. Results: A total of 39 children completed the treatment and follow-up and were included in the final analysis (20 in experimental group and 19 in control group). The baseline characteristics were balanced and comparable between the two groups (p > 0.05). Regarding the primary outcomes, efficacy analysis revealed that the cure rate was significantly higher in the experimental group than in the control group (65.0% vs. 26.3%, p < 0.05). However, there were no significant differences between the groups in effective rate (experimental group: 95.0% vs. control group: 89.5%) or the number of cases requiring subsequent treatment (experimental group: 2 cases vs. control group: 3 cases) (p > 0.05). Furthermore, no statistical difference was observed between the two groups in secondary outcomes, including operative time, postoperative drainage, follow-up duration, or the incidence of postoperative complications (p > 0.05). Conclusions: ICGL-guided partial resection of mLM + penetration sclerotherapy improves postoperative outcomes in mLM. By enabling real-time intraoperative assessment of mLM lesion extent, this strategy facilitates resection of the main lesion and precise sclerotherapy of residual microcysts. These findings validate the significant application value of the ICGL in personalized treatment for mLM. Full article

Background/Objectives: Stress urinary incontinence (SUI) remains a common and functionally relevant complication after radical prostatectomy (RP) and substantially impairs quality of life (QoL). Although pelvic floor muscle training (PFMT) is guideline-recommended, its real-world effectiveness is often limited by accessibility, standardization, and adherence. Digital health interventions may improve adherence to PFMT, potentially influencing continence recovery. We conducted a multicenter randomized controlled trial to evaluate whether a structured, modular app-based PFMT program improves early continence recovery compared with conventional physiotherapist-guided training. Methods: Between September 2022 and September 2024, 62 preoperatively continent men undergoing radical prostatectomy were enrolled in this multicenter randomized controlled trial (Pelvintense). Both groups received perioperative PFMT: Patients were randomized 1:1 to either a modular app-based PFMT program (intervention group) or a standard physiotherapist-guided PFMT (control group). Both app-based PFMT and standard physiotherapist-guided PFMT started three weeks before surgery and continued for 90 days postoperatively. The primary endpoint was continence at 90 days, defined as ICIQ-SF Q1 = 0 (absence of involuntary SUI). Secondary endpoints included continence sub-scores, QoL, erectile function, adherence, and decision regret. Analyses were performed using a modified intention-to-treat approach applying logistic regression and non-parametric tests with sensitivity analyses. Results: A total of 62 patients were included in the study and randomized, with 31 allocated to the app-based PFMT arm and 31 to the standard physiotherapist-guided arm. Three patients in the control arm withdrew consent for data usage after randomization, resulting in a modified intention-to-treat population of 59 patients. At 90 days, continence rates were higher in the app-based group compared with the control group (74.2% versus 21.4%; p < 0.001), corresponding to an absolute risk reduction of 52.8% and a number needed to treat of two. In multivariable analysis, participation in the app-based program was independently associated with higher odds of continence recovery (odds ratio 13.80, 95%-confidence interval 3.22–59.12; p < 0.001). Continence at 30 days and continence-related QoL favored the intervention, whereas no significant differences were observed in erectile function at 90 days. Adherence to the PFMT was higher in the intervention group. Sensitivity analyses confirmed the robustness of the primary outcome. Conclusions: In this randomized controlled trial, a modular app-based PFMT program was associated with early continence recovery after prostatectomy compared with the standard-of-care physiotherapist-guided PFMT. Improved adherence, modular progression of exercises, and a more structured training delivery may have contributed to the effect. App-based PFMT might represent a scalable strategy to implement guideline-recommended supportive care. These findings warrant confirmation in studies with a longer follow-up. Full article

Objective: To investigate the association between pelvic incidence (PI) and fixation failure following single-level transforaminal lumbar interbody fusion (TLIF) for low-grade spondylolisthesis and to identify risk factors for pedicle screw loosening. Methods: This retrospective study included 80 patients who underwent single-level TLIF and were divided into a high PI group (n = 40) and a normal/low PI group (n = 40). Radiographic parameters including PI, lumbar lordosis (LL), pelvic tilt (PT), sacra l slope (SS), listhesis magnitude, and PI–LL mismatch were evaluated pre- and postoperatively. Screw loosening and fusion status were assessed at 6, 12, and 24 months. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Results: The high PI group demonstrated significantly higher screw loosening rates than the normal/low PI group at all follow-up time points, with a rate of 57.5% versus 28.2% at 24 months (p = 0.012). Fusion rates were comparable between groups. Multivariate analysis identified high PI and residual listhesis were independent risk factors for screw loosening (Odds ratio 1.05 and 1.35). PI–LL mismatch > 10° showed higher odds but were not statistically significant. Conclusions: High PI is associated with an increased risk of pedicle screw loosening after single-level TLIF. Careful preoperative assessment and postoperative monitoring may help reduce fixation-related complications. Full article