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Alendronate treatment improves bone–pedicle screw interface fixation in posterior lateral spine fusion: An experimental study in a porcine model

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Abstract

The bone–screw interface has been indicated as the weak link in pedicle screw spine fixation. Bisphosphonate treatment may have the effect of improving bone–screw interface fixation in spine fusion by inhibiting bone resorption. An experimental study was conducted using a porcine model to evaluate the influence of alendronate treatment on bone–pedicle screw interface fixation. Eleven pigs in the treatment group received alendronate 10 mg/day orally for three months postoperatively. The other 11 pigs served as a control group. Posterior lateral fusion with the CD Horizon pedicle screw system was performed with autograft on the lumbar spine on all animals. Biomechanical torsion test and histomorphometric parameters of screw fixation were evaluated three months after the operation. The maximum torque and initial angular stiffness of the treatment group was higher than that of the control group, but there was no statistical significance. The bone–screw contact surface was 23.3 ± 10% for the treatment group and 9.8 ± 5.9% for the control group (P < 0.01). This study indicated that alendronate treatment increased bone purchase of stainless steel screw surfaces.

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References

  1. Chapman JR, Harrington RM, Lee KM (1996) Factors affecting the pullout strength of cancellous bone screws. J Biomech Eng 118:391–398

    Article  CAS  PubMed  Google Scholar 

  2. Christensen FB, Dalstra M, Sejling F (2000) Titanium-alloy enhances bone-pedicle screw fixation: mechanical and histomorphometrical results of titanium-alloy versus stainless steel. Eur Spine J 9:97–103

    Article  CAS  PubMed  Google Scholar 

  3. Davne SH, Myers DL (1992) Complications of lumbar spinal fusion with transpedicular instrumentation. Spine 17:S184–S189

    Article  CAS  PubMed  Google Scholar 

  4. DeCoster TA, Heetderks DB, Downey DJ (1990) Optimizing bone screw pullout force. J Orthop Trauma 4:169–174

    Article  CAS  PubMed  Google Scholar 

  5. Dickman CA, Fessler RG, MacMillan M (1992) Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg 77:860–870

    Article  CAS  PubMed  Google Scholar 

  6. Frenkel SR, Jaffe WL, Valle CD et al (2001) The effect of alendronate (Fosamax) and implant surface on bone integration and remodeling in a canine model. J Biomed Mater Res 58:645–650

    Article  CAS  PubMed  Google Scholar 

  7. George DC, Krag MH, Johnson CC (1991) Hole preparation techniques for transpedicle screws. Effect on pull-out strength from human cadaveric vertebrae. Spine 16:181–184

    CAS  PubMed  Google Scholar 

  8. Gundersen HJ, Jensen EB (1987) The efficiency of systematic sampling in stereology and its prediction. J Microsc 147(Pt 3):229–263

    CAS  PubMed  Google Scholar 

  9. Hilding M, Ryd L, Toksvig-Larsen S (2000) Clodronate prevents prosthetic migration: a randomized radiostereometric study of 50 total knee patients. Acta Orthop Scand 71:553–557

    CAS  PubMed  Google Scholar 

  10. Jacobs JJ, Sumner DR, Galante JO (1993) Mechanisms of bone loss associated with total hip replacement. Orthop Clin North Am 24:583–590

    CAS  PubMed  Google Scholar 

  11. Krag MH (1990) Spinal instrumentation: biomechanics of transpedicle spinal fixation. In: Weinstein JN, Wiesel SW (eds) In the lumbar spine. W.B. Saunders, Philadelphia, pp 916–940

    Google Scholar 

  12. Krag MH, Beynnon BD, Pope MH (1988) Depth of insertion of transpedicular vertebral screws into human vertebrae: effect upon screw-vertebra interface strength. J Spinal Disord 1:287–294

    Article  CAS  PubMed  Google Scholar 

  13. Kwok AW, Finkelstein JA, Woodside T (1996) Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone. Spine 21:2429–2434

    Article  CAS  PubMed  Google Scholar 

  14. Li J, Mori S, Kaji Y (2000) Concentration of bisphosphonate (incadronate) in callus area and its effects on fracture healing in rats. J Bone Miner Res 15:2042–2051

    Article  CAS  PubMed  Google Scholar 

  15. Luckman SP, Hughes DE, Coxon FP (1998) Nitrogen-containing bisphosphonates inhibit the mevalonate pathway and prevent post-translational prenylation of GTP-binding proteins, including Ras. J Bone Miner Res 13:581–589

    Article  CAS  PubMed  Google Scholar 

  16. Lugero GG, de Falco Caparbo V, Guzzo ML (2000) Histomorphometric evaluation of titanium implants in osteoporotic rabbits. Implant Dent 9:303–309

    Article  CAS  PubMed  Google Scholar 

  17. Mochida Y, Bauer TW, Akisue T (2002) Alendronate does not inhibit early bone apposition to hydroxyapatite-coated total joint implants: a preliminary study. J Bone Joint Surg 84A:226–235

    Google Scholar 

  18. Ohlin A, Karlsson M, Duppe H (1994) Complications after transpedicular stabilization of the spine. A survivorship analysis of 163 cases. Spine 19:2774–2779

    Article  CAS  PubMed  Google Scholar 

  19. Petersen MM, Lauritzen JB, Pedersen JG (1996) Decreased bone density of the distal femur after uncemented knee arthroplasty. A 1-year follow-up of 29 knees. Acta Orthop Scand 67:339–344

    CAS  PubMed  Google Scholar 

  20. Pihlajamaki H, Myllynen P, Bostman O (1997) Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg Br 79:183–189

    Article  Google Scholar 

  21. Russell RG, Rogers MJ (1999) Bisphosphonates: from the laboratory to the clinic and back again. Bone 25:97–106

    Article  CAS  PubMed  Google Scholar 

  22. Sanden B, Olerud C, Johansson C (2001) Improved bone-screw interface with hydroxyapatite coating: an in vivo study of loaded pedicle screws in sheep. Spine 26:2673–2678

    Article  CAS  PubMed  Google Scholar 

  23. Soininvaara TA, Jurvelin JS, Miettinen HJ (2002) Effect of alendronate on periprosthetic bone loss after total knee arthroplasty: a one-year, randomized, controlled trial of 19 patients. Calcif Tissue Int 71:472–477

    Article  CAS  PubMed  Google Scholar 

  24. Tokugawa Y, Shirota T, Ohno K (2003) Effects of bisphosphonate on bone reaction after placement of titanium implants in tibiae of ovariectomized rats. Int J Oral Maxillofac Implants 18:66–74

    PubMed  Google Scholar 

  25. Tonino RP, Meunier PJ, Emkey R et al (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group. J Clin Endocrinol Metab 85:3109–3115

    Article  CAS  PubMed  Google Scholar 

  26. Venesmaa PK, Kroger HP, Jurvelin JS (2003) Periprosthetic bone loss after cemented total hip arthroplasty: a prospective 5-year dual energy radiographic absorptiometry study of 15 patients. Acta Orthop Scand 74:31–36

    Article  PubMed  Google Scholar 

  27. Venesmaa PK, Kroger HP, Miettinen HJ (2001) Alendronate reduces periprosthetic bone loss after uncemented primary total hip arthroplasty: a prospective randomized study. J Bone Miner Res 16:2126–2131

    Article  CAS  PubMed  Google Scholar 

  28. Wilkinson JM, Hamer AJ, Rogers A (2003) Bone mineral density and biochemical markers of bone turnover in aseptic loosening after total hip arthroplasty. J Orthop Res 21:691–696

    Article  CAS  PubMed  Google Scholar 

  29. Wilkinson JM, Stockley I, Peel NF et al (2001) Effect of pamidronate in preventing local bone loss after total hip arthroplasty: a randomized, double-blind, controlled trial. J Bone Miner Res 16:556–564

    Article  CAS  PubMed  Google Scholar 

  30. Wittenberg RH, Shea M, Swartz DE (1991) Importance of bone mineral density in instrumented spine fusions. Spine 16:647–652

    Article  CAS  PubMed  Google Scholar 

  31. Yaffe A, Iztkovich M, Earon Y (1997) Local delivery of an amino bisphosphonate prevents the resorptive phase of alveolar bone following mucoperiosteal flap surgery in rats. J Periodontol 68:884–889

    CAS  PubMed  Google Scholar 

  32. Zindrick MR, Wiltse LL, Widell EH et al (1986) A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop 99–112

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Acknowledgements

The authors thank Anette Milton and Lisa Feng for technical assistance. This study was partly supported by Gigtforeningen (The Association of Rheumatology) (J.nr.233-845-07.06.01). Medtronic Sofamor Danek provided instrumentation for the first 20 operations.

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Authors and Affiliations

  1. Orthopaedic Research Laboratory, Orthopedic Department, Spine Section E, Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark

    Qingyun Xue, Haisheng Li, Xuenong Zou, Michel Dalstra, Martin Lind, Finn B. Christensen & Cody Bünger

  2. Department of Orthopaedics, Beijing Hospital, Beijing, China

    Qingyun Xue

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  1. Qingyun Xue
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  2. Haisheng Li
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Correspondence to Qingyun Xue.

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Xue, Q., Li, H., Zou, X. et al. Alendronate treatment improves bone–pedicle screw interface fixation in posterior lateral spine fusion: An experimental study in a porcine model. International Orthopaedics (SICOT) 34, 447–451 (2010). https://doi.org/10.1007/s00264-009-0759-4

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  • DOI: https://doi.org/10.1007/s00264-009-0759-4

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