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The Benefits of Cement Augmentation of Pedicle Screw Fixation Are Increased in Osteoporotic Bone: A Finite Element Analysis

  • Biomechanics
  • Published:
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Abstract

Study Design

Biomechanical study using a finite element model of a normal and osteoporotic lumbar vertebrae comparing resistance with axial pullout and bending forces on polymethylmethacrylate-augmented and non-augmented pedicle screws.

Objective

To compare the effect of cement augmentation of pedicle screw fixation in normal and osteoporotic bone with 2 different techniques of cement delivery.

Summary of Background Data

Various clinical and biomechanical studies have addressed the benefits of cement augmentation of pedicle screws, but none have evaluated whether this effect is similar, magnified, or attenuated in osteoporotic bone compared with normal bone. In addition, no study has compared the biomechanical strength of augmented pedicle screws using cement delivery through the pedicle screw with delivery through a pilot hole.

Methods

This study was funded by a grant from DePuy Synthes Spine. Normal and osteoporotic lumbar vertebrae with pedicle screws were simulated. The models were tested for screw pullout strength with and without cement augmentation. Two methods of cement delivery were also tested. Both methods were tested using 1 and 2.5 cm3 volume of cement infiltrated in normal and oste- oporotic bone.

Results

The increase in screw pullout force was proportionally greater in osteoporotic bone with equivalent volumes of cement delivered. The researchers found that 1 and 2.5 cm3 of cement infiltrated bone volume resulted in an increase in pullout force by about 50% and 120% in normal bone, and by about 64% and 156% in osteoporotic bone, respectively. The delivery method had only a minimal effect on pullout force when 2.5 cm3 of cement was injected (<4% difference).

Conclusions

Cement augmentation increases the fixation strength of pedicle screws, and this effect is proportionately greater in osteo- porotic bone. Cement delivery through fenestrated screws and delivery through a pilot hole result in comparable pullout strength at higher cement volumes.

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Authors and Affiliations

  1. Department of Mechanical Engineering, College of Engineering, Temple University, 1947 North 12th Street, Philadelphia, PA, 19104, USA

    Wenhai Wang PhD & George R. Baran PhD

  2. Artemis Health Institute, Sector 51, Gurgaon, 122001, Haryana, India

    Hitesh Garg MD

  3. Shriners Hospitals for Children—Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA

    Randal R. Betz MD & Patrick J. Cahill MD

  4. DePuy Synthes Spine, Inc., 325 Paramount Drive, Raynham, MA, 02767, USA

    Missoum Moumene PhD

Authors
  1. Wenhai Wang PhD
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  2. George R. Baran PhD
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  3. Hitesh Garg MD
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  4. Randal R. Betz MD
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  5. Missoum Moumene PhD
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  6. Patrick J. Cahill MD
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Corresponding author

Correspondence to Patrick J. Cahill MD.

Additional information

Author disclosures: WW (grant from DePuy Synthes Spine); GRB (grant from DePuy Synthes Spine; consultancy for DePuy Synthes Spine and Globus Medical); HG (none); RRB (grant from DePuy Synthes Spine; consultancy for DePuy Synthes Spine, Orthocom, SpineGuard, Medtronic; payment for lectures including service on speakers bureaus from DePuy Synthes Spine; royalties from DePuy Synthes Spine, Medtronic; stock/stock options from SpineGuard, MiMedx, Orthocon, Orthobond); MM (grant from DePuy Synthes Spine); PJC (grant from DePuy Synthes Spine; consultancy for DePuy Synthes Spine and Medtronic; grants from DePuy Synthes Spine; payment for lectures including service on speakers bureaus from Medtronic; payment for manuscript preparation from DePuy Synthes Spine; payment for the development of educational presentations from Medtronic).

This study was funded by a grant from DePuy Synthes Spine.

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Wang, W., Baran, G.R., Garg, H. et al. The Benefits of Cement Augmentation of Pedicle Screw Fixation Are Increased in Osteoporotic Bone: A Finite Element Analysis. Spine Deform 2, 248–259 (2014). https://doi.org/10.1016/j.jspd.2014.03.002

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  • DOI: https://doi.org/10.1016/j.jspd.2014.03.002

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