Methods: We analyzed data from 101 patients who underwent spinopelvic surgery involving 202 S2AI screws. Postoperative computed tomography (CT) images were reviewed to identify screw deviations. The reconstructed fluoroscopic views from CT, including the inlet, OI, and IO views, were assessed for their effectiveness in detecting deviations. An experimental study using pelvic bone models simulated scenarios where deviations were undetectable in the inlet view but visible in the OI view. Results: Screw deviations were identified in 12 cases (11.9%) and 13 screws (6.4%), including six screws (3.0%) with anterior deviations and seven screws (3.5%) with posterior deviations. The accurate inlet view detected anterior deviations in three of the five cases analyzed with reconstructed images. However, two cases of anterior deviation were missed due to an insufficient inlet view caused by a 30° caudal tilting angle. In contrast, the OI view successfully identified all cases of both anterior and posterior deviations. In particular, deviations above the arcuate line of the pelvic brim were not detectable in the inlet view. Conclusions The inlet view alone is inadequate for detecting anterior deviations, especially those located above the arcuate line of the pelvis. The OI and IO views demonstrated greater effectiveness in identifying deviations, thereby enhancing the accuracy and safety of S2AI screw placement.

Apical periodontitis is the inflammatory lesion of apical periodontal tissue caused by tooth decay, etc. The treatment requires infected root canal therapy that can get rid of infected pulpy, septic matter and bacteria inside the tooth. This report outlines the case of a 77-year-old male patient who was diagnosed as apical periodontitis on the lower right first molar. Dentist advised the patient to have a root canal treatment, but he strongly resisted the treatment and did not agree. So we treated him with Kampo medicine, hainosankyuto and rikkosan as a result his condition has been stable for more than 3 years without using antibiotics or analgesic. If apical periodontitis is left untreated, there would be a risk of tooth conditions gradually getting worse. In cases where standard dental treatment is difficult, Kampo medicine may be useful and hopeful.