“…Despite technological advances, implant failures, such as screw bending, breakage, and loosening still occur [2,10,40]. It is well established in the literature that the holding power of the pedicle screw is influenced by bone mineral density [5], geometry of the screw [1,20,[25][26][27] and the screw insertion technique employed by the surgeon [5,14,33,38]. It has been reported that the holding power of the pedicle screw is significantly influenced by the size and technique of the pilot hole [5,7,14,15,33].…”