The fusion surgery is a standard treatment for scoliosis. Fatigue-related failure is one common cause for the fusion surgery implant. Due to the high cost of revision surgery, it is of clinical value to study the fatigue behaviors of the spinal implants under physiological spinal loads. In the literature, biomechanical tests and finite element (FE) methods have been used to study the fatigue of the spinal implants. Compared with biomechanical tests, FE analysis has the advantage of low cost and high efficiency. Due to the high computational cost, no FE study has been modeled the exact geometry of the pedicle screw (including the thread) in the screw-bone connection within the multi-level spine FE model. This study introduced a feasible FEbased method to predict the fatigue behaviors of the spinal implants with exact geometry of pedicle screw. One previouslyvalidated FE spine model was utilized to provide physiological spinal loads and was bilaterally fused with pedicle screws and rods at L3-L4 spine levels. The exact geometry of the pedicle screw was simulated in this study for accurate stress prediction. The fused spine FE model was subjected to six loading directions (flexion/extension, left/right lateral bending, and left/right axial rotation). For each loading direction, a pure bending moment of 10 Nm was tested. First, FE analysis was performed for one loading cycle. Range of motion, maximum von Mises stress values of the spinal implants were recorded and compared for the six tested loading conditions. Then, based on the stress/strain history of the spinal implants for one loading cycle provided by the FE simulation, fatigue life cycles of the spinal implants were calculated using strain-based Smith-Watson-Topper equation. Flexion produced the largest range of motion at the adjacent level. Axial rotation produced the largest von Mises stress in the spinal implants. Except for lateral bending, the von Mises stress predicted in the screws fused at the superior vertebra was larger than that in the screws fused at inferior vertebra. The method introduced in this study will be used to study different screw fixation methods in the future work.