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Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Transpedicular fixation can be challenging in the osteoporotic spine. Expansive pedicle screw (EPS) and polymethylmethacrylate-augmented pedicle screw (PMMA-PS) were both used to increase screw stability. However, there are a little or no biomechanical comparisons of EPS and PMMA-PS, especially in primary spinal surgery in osteoporotic vertebrae. The purpose of this study was to compare the stability of EPS and PMMA-PS in primary spinal surgery.

Materials and methods

Fifteen osteoporotic vertebrae were randomly divided into three groups. The conventional pedicle screw (CPS) was inserted in CPS group, the pilot hole was filled with PMMA followed by CPS insertion in PMMA-PS group, and EPS was inserted in EPS group. Twenty-four hours later, X-ray and CT examination and biomechanical tests were performed to all vertebrae.

Results

In PMMA-PS group, PMMA existed in bone tissue around the CPS in both vertebral body and pedicle of vertebral arch, and PMMA surrounding the screw formed a spindle-shaped structure in vertebral body. In EPS group, anterior part of EPS presented an obvious expansion in vertebral body and formed a clawlike structure. Screw stabilities in PMMA-PS and EPS groups were significantly enhanced compared with those in CPS group (P < 0.05). However, there was no significant difference between PMMA-PS and EPS groups (P > 0.05).

Conclusion

Expansive pedicle screw can markedly enhance screw stability with a similar effect to the traditional method of screw augmentation with PMMA in primary surgery in osteoporotic vertebrae. In addition, EPS can overcome pedicle fracture, leakage and compression caused by lager screw and augmentation with PMMA. We propose that EPS is an effective, safe and easy method and has a great application potential in augmentation of screw stability in osteoporosis in clinic.

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References

  1. Boucher HH (1959) A method of spinal fusion. J Bone Joint Surg Br 41-B:248–259

    PubMed  CAS  Google Scholar 

  2. Tokuhashi Y, Ajiro Y, Umezawa N (2008) Outcomes of posterior fusion using pedicle screw fixation in patients > or = 70 years with lumbar spinal canal stenosis. Orthopedics 31:1096

    PubMed  Google Scholar 

  3. Fisher C, Singh S, Boyd M et al (2009) Clinical and radiographic outcomes of pedicle screw fixation for upper thoracic spine (T1–5) fractures: a retrospective cohort study of 27 cases. J Neurosurg Spine 10:207–213

    Article  PubMed  Google Scholar 

  4. Hee HT, Yu ZR, Wong HK (2007) Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine (Phila Pa 1976) 32:1533–1542

    Article  Google Scholar 

  5. 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 61:531–537 discussion 537–538

    Article  PubMed  Google Scholar 

  6. Halverson TL, Kelley LA, Thomas KA et al (1994) Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976) 19:2415–2420

    Article  Google Scholar 

  7. Mclain RF, McKinley TO, Yerby SA et al (1997) The effect of bone quality on pedicle screw loading in axial instability. A synthetic model. Spine (Phila Pa 1976) 22:1454–1460

    Article  CAS  Google Scholar 

  8. Reitman CA, Nguyen L, Fogel GR (2004) Biomechanical evaluation of relationship of screw pullout strength, insertional torque, and bone mineral density in the cervical spine. J Spinal Disord Tech 17:306–311

    Article  PubMed  Google Scholar 

  9. Polly DW Jr, Orchowski JR, Ellenbogen RG (1998) Revision pedicle screws. Bigger, longer shims—what is best? Spine (Phila Pa 1976) 23:1374–1379

    Article  Google Scholar 

  10. Brantley AG, Mayfield JK, Koeneman JB et al (1994) The effects of pedicle screw fit. An in vitro study. Spine (Phila Pa 1976) 19:1752–1758

    Article  CAS  Google Scholar 

  11. Kiner DW, Wybo CD, Sterba W et al (2008) Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976) 33:2618–2622

    Article  Google Scholar 

  12. Wittenberg RH, Lee KS, Shea M et al (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop Relat Res 296:278–287

    PubMed  Google Scholar 

  13. Pfeifer BA, Krag MH, Johnson C (1994) Repair of failed transpedicle screw fixation-A biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction. Spine (Phila Pa 1976) 19:350–353

    Article  CAS  Google Scholar 

  14. Sarzier JS, Evans AJ, Cahill DW (2002) Increased pedicle screw pull out strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg 96(3 Suppl):309–312

    PubMed  Google Scholar 

  15. Kayanja M, Evans K, Milks R et al (2006) The mechanics of polymethylmethacrylate augmentation. Clin Orthop Relat Res 443:124–130

    Article  PubMed  Google Scholar 

  16. Hriano T, Hasegawa K, Washio T et al (1998) Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord 11:493–497

    Google Scholar 

  17. Lonstein JE, Denis F, Perra JH et al (1999) Complications associated with pedicle screws. J Bone Joint Surg 81:1519–1528

    PubMed  CAS  Google Scholar 

  18. Konno S, Olmaker K, Byrod G (1994) The European Spine Society Aero Med Prize 1994: acute thermal nerve root injury. Eur Spine J 3:299–302

    Article  PubMed  CAS  Google Scholar 

  19. Lei W, Wu Z (2006) Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J 15:321–326

    Article  PubMed  Google Scholar 

  20. Cook SD, Salkeld SL, Whitecloud TS 3rd et al (2000) Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord 13:230–236

    Article  PubMed  CAS  Google Scholar 

  21. Cook SD, Salkeld SL, Stanley T et al (2004) Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J 4:402–408

    Article  PubMed  Google Scholar 

  22. Cook SD, Barbera J, Rubi M et al (2001) Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J 1:109–114

    Article  PubMed  CAS  Google Scholar 

  23. Burval DJ, McLain RF, Milks R et al (2007) Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976) 32:1077–1083

    Article  Google Scholar 

  24. Chang MC, Liu CL, Chen TH (2008) Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976) 33:E317–E324

    Article  Google Scholar 

  25. Moon BJ, Cho BY, Choi EY et al (2009) Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc 46:305–311

    Article  PubMed  Google Scholar 

  26. Wan SY, Lei W, Wu ZX et al (2008) Micro-CT evaluation and histological analysis of screw-bone interface of expansive pedicle screw in osteoporotic sheep. Chin J Traumatol 11:72–77

    PubMed  Google Scholar 

  27. Leung KS, Siu WS, Li SF et al (2006) An in vitro optimized injectable calcium phosphate cement for augmenting screw fixation in osteopenic goats. J Biomed Mater Res B Appl Biomater 78:153–160

    PubMed  Google Scholar 

  28. Hashemi A, Bednar D, Ziada S et al (2009) Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J 9:404–410

    Article  PubMed  Google Scholar 

  29. Derincek A, Wu C, Mehbod A et al (2006) Biomechanical comparison of anatomic trajectory pedicle screw versus injectable calcium sulfate graft-augmented pedicle screw for salvage in cadaveric thoracic bone. J Spinal Disord Tech 19:286–291

    Article  PubMed  Google Scholar 

  30. Yi X, Wang Y, Lu H et al (2008) Augmentation of pedicle screw fixation strength using an injectable calcium sulfate cement: an in vivo study. Spine (Phila Pa 1976) 33:2503–2509

    Article  Google Scholar 

  31. Bostan B, Esenkaya I, Gunes T et al (2009) A biomechanical comparison of polymethylmethacrylate- reinforced and expansive pedicle screws in pedicle-screw revisions. Acta Orthop Traumatol Turc 43:272–276

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was supported by The National High Technology Research and Development Program of China (863 Program) (2007AA02Z468).

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Authors and Affiliations

  1. Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi Province, 710032, People’s Republic of China

    Da Liu, Zi-xiang Wu, Suo-chao Fu, Ming-xuan Gao, Lei Shi & Wei Lei

  2. Department of Orthopaedics, General Hospital of Chengdu Military Command, No. 270, Tianhui Road, Chengdu, Sichuan Province, 610083, People’s Republic of China

    Xian-ming Pan

Authors
  1. Da Liu
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  2. Zi-xiang Wu
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  7. Wei Lei
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Correspondence to Wei Lei.

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Liu, D., Wu, Zx., Pan, Xm. et al. 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, 1227–1232 (2011). https://doi.org/10.1007/s00402-011-1290-9

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  • DOI: https://doi.org/10.1007/s00402-011-1290-9

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