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Stability and Spine Pedicle Screws Fixation Strength—A Comparative Study of Bone Density and Insertion Angle

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Abstract

Study Design

Analysis of insertion angle and bone density on the pedicle screw fixation strength with a novel testing protocol that accounts for the articular processes.

Objective

To analyze the relationship between pedicle screw fixation strength and bone mineral density for different transverse screw insertion angles.

Summary of Background Data

The stability of the screw can become compromised by demineralization of the vertebral bone due to diseases such as osteoporosis. A weakening of the bone-screw interface, and therefore, a decrease in the fixation strength of the screw, leads to an increased probability of instrument failure, most commonly by screw loosening or screw pullout.

Methods

Using the ASTM F543 as reference, we performed pullout tests with an Instron mechanical testing machine of a posterior fixation construct mimicking two pedicle screws connected at a distance of 40 mm as suggested by the ASTM F1717 on four densities of polyurethane foam in accordance with the ASTM F1839-08 standard to simulate bone densities ranging from osteoporotic (5 pcf) to higher than normal (20 pcf) in four transverse insertion angles.

Results

A linear regression with two independent variables was found to be Y = −354.8812 + 91.8102 × X1 − 6.8747 × X2 (X1 = density [pcf], X2 = angle [degrees]), with a correlation coefficient of 0.95 for all the experimental data.

Conclusions

Pedicle screw insertion angle and bone density are critical to pullout strength. However, in osteoporotic bone, the insertion angle has only a marginal influence on pullout strength.

Level of Evidence

V.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Illinois at Chicago, 835 South Wolcott Ave., Chicago, IL, 60612, USA

    Farid Amirouche PhD

  2. Department of Orthopaedic Surgery, University of Illinois at Chicago, 835 South Wolcott Ave., Chicago, IL, 60612, USA

    Farid Amirouche PhD & Giovanni F. Solitro PhD

  3. College of Medicine, University of Illinois at Chicago, 835 South Wolcott Ave., Chicago, IL, 60612, USA

    Brenden P. Magnan BS

Authors
  1. Farid Amirouche PhD
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  2. Giovanni F. Solitro PhD
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  3. Brenden P. Magnan BS
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Correspondence to Farid Amirouche PhD.

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Author disclosures

FA (none); GFS (none); BPM (none).

The work was partially supported by Aurelio M. Caccomo Family Foundation.

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Amirouche, F., Solitro, G.F. & Magnan, B.P. Stability and Spine Pedicle Screws Fixation Strength—A Comparative Study of Bone Density and Insertion Angle. Spine Deform 4, 261–267 (2016). https://doi.org/10.1016/j.jspd.2015.12.008

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  • DOI: https://doi.org/10.1016/j.jspd.2015.12.008

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