Background: In the literature, there is a large variation in the reported misplacement rates of pedicle screws.The use of minimally invasive surgical techniques is increasing and as such there has only been a small amount of data to look at the misplacement rate of percutaneously inserted thoracic and lumbar pedicle screws.Methods: A retrospective analysis of post-operative computed tomography (CT) scans were performed on 108 patients who underwent minimally invasive percutaneously inserted thoracic and lumbar pedicle screws by a single surgeon. Analysis of the screw trajectory using strict guidelines was performed using multiplanar reconstruction CT scan data to determine the accuracy of the pedicle screws.Results: A total of 614 screws were inserted in vertebral levels T2 to S1. Twenty-five (4.07%) screws were considered misplaced having breached the pedicular cortex. Thoracic pedicle screws had a statistically higher misplacement rate than lumbar pedicle screws (14.67% vs. 2.60% respectively, P<0.001). A single screw required replacement (0.16%) and there were no permanent neurological deficits. The misplacement rates were lower than those reported for open screw placement and equivalent to 3D CT navigated misplacement rates.Conclusions: Percutaneously inserted pedicle screws using 2D fluoroscopy offers a safe and accurate option for spinal stabilisation with an extremely low misplacement rate and morbidity. Overall, the low misplacement rates were equivalent and in most cases lower compared to open and computer assisted navigation techniques.However, we would recommend that given a misplacement rate of 14.67% for thoracic pedicle screws that computer assisted navigation may be able to offer further improvements in accuracy.

The editorial team greatly appreciates the reviewers who have dedicated their considerable time and expertise to the journal's rigorous editorial process over the past 12 months, regardless of whether the papers are finally published or not. In 2019, a total of 317 papers were published in the journal, with a median time to first decision of 22 days and a median time from submission to publication of 55 days. The editors would like to express their sincere gratitude to the following reviewers for their generous contribution in 2019:Abbas, Azhar

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