A Biomechanical Study to Evaluate the Effect of PMMA Augmentation and Restoration of the Strength of Cervical Vertebral Screws Inserted in an Osteoporotic Vertebral Body

Chen, Chun; Zhang, Weidong; Li, Dongxu; Sun, Ping; Wu, Changfu; Ouyang, Jun

doi:10.1097/bsd.0b013e31825bfb69

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…Our previous research has shown that this rate is appropriate to avoid damage to the vertebrae by preventing sudden pullout of the screw 21 . Failure was defined as the point at which there was a precipitous drop in the load-displacement curve.…”

Section: Test Groupsmentioning

confidence: 99%

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

Qian

Chen

et al. 2020

Orthopaedic Surgery

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Objective This study aimed to investigate the strength of a novel micro‐dynamic pedicle screw by comparing it to the traditional pedicle screw. Methods Forty‐five lumbar vertebrae received a traditional pedicle screw on one side and a micro‐dynamic pedicle screw on the other side as follows (traditional group vs micro‐dynamic group): 15 vertebrae underwent instant pull‐out testing; 15 vertebrae underwent 5000‐cyclic fatigue loading testing; and 15 vertebrae underwent 10,000‐cyclic fatigue loading testing and micro‐computed tomography (micro‐CT) scanning. The peek pull‐out force and normalized peek pull‐out force after instant pull‐out testing, 5000‐cyclic and 10,000‐cyclic fatigue loading testing were recorded to estimate the resistance of two types of screws. Bone mineral density was recorded to investigate the strength of the different screws in osteoporotic patients. And the semidiameter of the screw insertion area on micro‐CT images after fatigue were compared to describe the performance between screw and bone surface. Results The bone mineral density showed a weak correlation with peek pull‐out force (r = 0.252, P = 0.024). The peek pull‐out force of traditional pedicle screw after 10,000‐cyclic fatigue loading were smaller than that of instant pull‐out test in both osteoporotic (P = 0.017) and healthy group (P = 0.029), the peek pull‐out force of micro‐dynamic pedicle screw after 10,000‐cyclic fatigue loading was smaller than that in instant pull‐out test in osteoporotic group (P = 0.033), but no significant difference in healthy group (P = 0.853). The peek pull‐out force in traditional group and micro‐dynamic group underwent instant pull‐out testing (P = 0.485), and pull‐out testing after 5000‐cyclic fatigue loading testing (P = 0.184) did not show significant difference. However, the peek pull‐out force in micro‐dynamic group underwent pull‐test after 10,000‐cyclic fatigue loading testing was significantly greater than that measured in traditional group (P = 0.005). The normalized peek pull‐out force of traditional groups underwent instant pull‐out testing, pull‐out test after 5000‐cyclic and 10,000‐cyclic fatigue loading testing significantly decreased as the number of cycles increased (P < 0.001); meanwhile, the normalized peek pull‐out force of micro‐dynamic groups remained consistent regardless of the number of cycles (P = 0.133). The semidiameter after the fatigue loading test of the traditional screw insertion area was significantly larger than that of the micro‐dynamic screw insertion area (P = 0.013). Conclusion The novel micro‐dynamic pedicle screw provides stronger fixation stability in high‐cyclic fatigue loading and non‐osteoporotic patients versus the traditional pedicle screw, but similar resistance in low‐cycle fatigue testing and osteoporotic group vs the traditional pedicle screw.

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Section: Test Groupsmentioning

confidence: 99%

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

Qian

Chen

et al. 2020

Orthopaedic Surgery

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“…At the level of C2, pedicle fixation has been shown to have twice the pullout over pars fixation. 13 In the subaxial spine, pedicle screws have been utilized from an anterior 2 - 28 or posterior approach. 13 , 18 - 21 While they place the vertebral artery and nerve root at increased risk, cervical pedicle screws allow for improved biomechanical strength.…”

Section: Resultsmentioning

confidence: 99%

“…PMMA augmentation has been described in the setting of anterior vertebral body screws [25][26][27][28][29][30][31][32] and odontoid fixation of the elderly. [29][30][31] Augmentation may occur prior to screw placement (cement-first technique) by injecting PMMA through a tapped screw hole or after screw placement (in situ technique) whereby cement is injected through a cannulated and fenestrated screw design.…”

Section: Screw Augmentationmentioning

confidence: 99%

“…54 The available data on human participants for this technique is limited to small case series. [25][26][27][28] Further, augmentation of anterior odontoid fixation in the elderly is described with PMMA at the anterior-inferior body of C2 to help reduce backout on a fully threaded screw. [29][30][31] Based on the current literature no definitive argument can be made to support PMMA augmentation; however, it has been employed in multiple circumstances by surgeons in an attempt to salvage anterior screw fixation.…”

Section: Screw Augmentationmentioning

confidence: 99%

“…Load sharing has been described via the use of anterior and supplementary posterior fixation to distribute the stress at the bone-implant interface 20,21,24 though this carries its own Posterior C2 pedicle 13 Posterior subaxial 13,[17][18][19][20][21] 3 Transarticular fixation with augmented wiring/hooks 35,38,41 Screw augmentation with PMMA 1 Anterior vertebral body screws [25][26][27][28]53 2 Odontoid screws [29][30][31][32]…”

Section: Load Sharingmentioning

confidence: 99%

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A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine

Oitment

Thornley

Koziarz

et al. 2022

Global Spine Journal

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Study Design Systematic review. Objectives Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. Results An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. Conclusion The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.

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Biomechanical Analysis of Differential Pull-Out Strengths of Bone Screws Using Cervical Anterior Transpedicular Technique in Normal and Osteoporotic Cervical Cadaveric Spines

Chen

et al. 2015

Spine

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A Biomechanical Study to Evaluate the Effect of PMMA Augmentation and Restoration of the Strength of Cervical Vertebral Screws Inserted in an Osteoporotic Vertebral Body

Cited by 7 publications

References 22 publications

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine

Biomechanical Analysis of Differential Pull-Out Strengths of Bone Screws Using Cervical Anterior Transpedicular Technique in Normal and Osteoporotic Cervical Cadaveric Spines

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