Biomechanical evaluation of the primary stability of pedicle screws after augmentation with an innovative bone stabilizing system
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
In today’s aging population, diminished bone quality often affects the outcome of surgical treatment. This occurs especially when surgical implants must be fixed to bone, as it occurs when lumbar fusion is performed with pedicle screws. Besides Polymethylmethacrylate (PMMA) injection, several techniques have been developed to augment pedicle screws. The aim of the current study was to evaluate the primary stability of an innovative system (IlluminOss™) for the augmentation of pedicle screws in an experimental cadaveric setup. IlluminOss™ is an innovative technology featuring cement with similar biochemical characteristics to aluminum-free glass-polyalkenoate cement (GPC).
Materials and methods
IlluminOss™ was inserted transpedicularly via a balloon/catheter system in 40 human cadaveric lumbar vertebrae. For comparability, each vertebra was treated bilaterally with pedicle screws, augmented and non-augmented. The maximum failure load during pull out test was documented by a universal material testing machine.
The results showed significantly higher failure loads for the augmented pedicle screws (Median 555.0 ± 261.0 N, Min. 220.0 N, Max. 1,500.0 N), compared to the native screws (Median 325.0 ± 312.1 N, Min. 29.0 N, Max. 1,400.0 N).
Based on these data, we conclude the IlluminOss™ system can be used to augment primary screw stability regarding axial traction, compared to native screws. The IlluminOss™ monomer offers ease of control for use in biological tissues. In contrast to PMMA, no relevant heat is generated during the hardening process and there is no risk of embolism. Further studies are necessary to evaluate the usefulness of the IlluminOss™ system in the in vivo augmentation of pedicle screws in the future.
- Wright, NC, Saag, KG (2012) From fracture risk prediction to evaluating fracture patterns: recent advances in the epidemiology of osteoporosis. Curr Rheumatol Rep.
- Bow, CH, Cheung, E, Cheung, CL, Xiao, SM, Loong, C, Soong, C, Tan, KC, Luckey, MM, Cauley, JA, Fujiwara, S, Kung, AW (2012) Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 23: pp. 879-885 CrossRef
- Jager, PL, Jonkman, S, Koolhaas, W, Stiekema, A, Wolffenbuttel, BH, Slart, RH (2011) Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int 22: pp. 1059-1068 CrossRef
- Shi, L, Wang, L, Zhang, Y, Guo, Z, Wu, ZX, Liu, D, Gao, MX, Chen, H, Fu, SC, Lei, W (2012) Improving fixation strength of pedicle screw by microarc oxidation treatment: an experimental study of osteoporotic spine in sheep. J Orthop Res.
- Liu, D, Wu, ZX, Pan, XM, Fu, SC, Gao, MX, Shi, L, Lei, W (2011) Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw. Arch Orthop Trauma Surg 131: pp. 1227-1232 CrossRef
- Cook, SD, Barbera, J, Rubi, M, Salkeld, SL, Whitecloud, TS (2001) Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J 1: pp. 109-114 CrossRef
- Amendola, L, Gasbarrini, A, Fosco, M, Simoes, CE, Terzi, S, Iure, F, Boriani, S (2011) Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol 12: pp. 193-199 CrossRef
- Krappinger, D, Kastenberger, TJ, Schmid, R (2012) Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures. Oper Orthop Traumatol.
- Burval, DJ, McLain, RF, Milks, R, Inceoglu, S (2007) Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976) 32: pp. 1077-1083 CrossRef
- Hu, MH, Wu, HT, Chang, MC, Yu, WK, Wang, ST, Liu, CL (2011) Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J 20: pp. 1281-1288 CrossRef
- Pinera, AR, Duran, C, Lopez, B, Saez, I, Correia, E, Alvarez, L (2011) Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation. Eur Spine J 20: pp. 408-414 CrossRef
- Li, Y, Cheng, H, Liu, ZC, Wu, JW, Yu, L, Zang, Y, He, Q, Lei, W, Wu, ZX (2013) In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep. J Spinal Disord Tech 26: pp. E118-E123 CrossRef
- Folsch, C, Goost, H, Figiel, J, Paletta, JR, Schultz, W, Lakemeier, S (2012) Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement. Biomed Tech (Berl) 57: pp. 473-480 CrossRef
- Becker, S, Chavanne, A, Spitaler, R, Kropik, K, Aigner, N, Ogon, M, Redl, H (2008) Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J 17: pp. 1462-1469 CrossRef
- Frankel, BM, D’Agostino, S, Wang, C (2007) A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 7: pp. 47-53 CrossRef
- Sawakami, K, Yamazaki, A, Ishikawa, S, Ito, T, Watanabe, K, Endo, N (2012) Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech 25: pp. E28-E35 CrossRef
- Chrea, B, Malempati, H, Campbell, JR, Khan, S, Ching, RP, Lee, MJ (2013) Enhancing pedicle screw fixation in the lumbar spine utilizing allograft bone plug interference fixation. J Spinal Disord Tech.
- Chao, KH, Lai, YS, Chen, WC, Chang, CM, McClean, CJ, Fan, CY, Chang, CH, Lin, LC, Cheng, CK (2013) Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys.
- Haasum, Y, Fastbom, J, Fratiglioni, L, Johnell, K (2012) Undertreatment of osteoporosis in persons with dementia? A population-based study. Osteoporos Int 23: pp. 1061-1068 CrossRef
- Burge, R, Dawson-Hughes, B, Solomon, DH, Wong, JB, King, A, Tosteson, A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22: pp. 465-475 CrossRef
- Dempster, DW (2011) Osteoporosis and the burden of osteoporosis-related fractures. Am J Manag Care 17: pp. S164-S169
- DeWald, CJ, Stanley, T (2006) Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976) 31: pp. S144-S151 CrossRef
- Lee, JH, Park, JW, Shin, YH (2012) The insertional torque of a pedicle screw has a positive correlation with bone mineral density in posterior lumbar pedicle screw fixation. J Bone Joint Surg Br 94: pp. 93-97 CrossRef
- Frankel, BM, Jones, T, Wang, C (2007) Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery 61: pp. 531-537 CrossRef
- Sarzier, JS, Evans, AJ, Cahill, DW (2002) Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg 96: pp. 309-312
- Pare, PE, Chappuis, JL, Rampersaud, R, Agarwala, AO, Perra, JH, Erkan, S, Wu, C (2011) Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976) 36: pp. E1210-E1214 CrossRef
- Deramond, H, Wright, NT, Belkoff, SM (1999) Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 25: pp. 17S-21S CrossRef
- Rodrigues, DC, Ordway, NR, Ma, CR, Fayyazi, AH, Hasenwinkel, JM (2011) An ex vivo exothermal and mechanical evaluation of two-solution bone cements in vertebroplasty. Spine J 11: pp. 432-439 CrossRef
- Petridis, AK, Maslehaty, H, Eichenhofer, T, Gillner, S, Scholz, M (2013) Pulmonary embolism associated with poly(methyl methacrylate) (PMMA) after vertebroplasty. A complication more often than one thinks. Acta Neurochir (Wien) 155: pp. 319-320 CrossRef
- Liu, FJ, Ren, H, Shen, Y, Ding, WY, Wang, LF (2012) Pulmonary embolism caused by cement leakage after percutaneous kyphoplasty: a case report. Orthop Surg 4: pp. 263-265 CrossRef
- Mozaffar, M, Radpay, MR, Zirakzadeh, H, Nabavizadeh, P, Sobhiye, MR, Motiei Langroudi, R (2012) Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty. J Vasc Surg 56: pp. 1107-1109 CrossRef
- Morita, K, Doi, K, Oue, H, Kajihara, S, Hayashi, K, Akagawa, Y (2012) Influence of formalin fixation on the implant stability quotient and mechanical characteristics of bone. Br J Oral Maxillofac Surg.
- Burkhart, KJ, Nowak, TE, Blum, J, Kuhn, S, Welker, M, Sternstein, W, Mueller, LP, Rommens, PM (2010) Influence of formalin fixation on the biomechanical properties of human diaphyseal bone. Biomed Tech (Berl) 55: pp. 361-365 CrossRef
- Liljenqvist, U, Hackenberg, L, Link, T, Halm, H (2001) Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67: pp. 157-163
- Chen, LH, Tai, CL, Lee, DM, Lai, PL, Lee, YC, Niu, CC, Chen, WJ (2011) Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord 12: pp. 33 CrossRef
- Hashemi, A, Bednar, D, Ziada, S (2009) Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J 9: pp. 404-410 CrossRef
- Chen, LH, Tai, CL, Lai, PL, Lee, DM, Tsai, TT, Fu, TS, Niu, CC, Chen, WJ (2009) Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon) 24: pp. 613-618 CrossRef
- Biomechanical evaluation of the primary stability of pedicle screws after augmentation with an innovative bone stabilizing system
Archives of Orthopaedic and Trauma Surgery
Volume 133, Issue 11 , pp 1493-1499
- Cover Date
- Print ISSN
- Online ISSN
- Springer Berlin Heidelberg
- Additional Links
- Lumbar fusion
- Pedicle screw
- Primary stability
- Glass-polyalkenoate cement
- Industry Sectors
- Author Affiliations
- 1. Centre for Orthopaedic and Trauma Surgery, University Medical Centre, Cologne, Germany
- 2. Department for Orthopaedic and Trauma Surgery, St. Vinzenz Hospital, Cologne, Germany
- 3. Department of Anatomy I, University of Cologne, Cologne, Germany
- 4. Centre for Orthopaedic and Trauma Surgery, Medizinisches Zentrum StädteRegion Aachen GmbH, Aachen, Germany