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

Wu, Changfu; Chen, Chun; Wu, Weidong; Zhang, Weidong; Sun, Ping; Fan, Jian‐Sheng; Bi, Zhenyu; Zhang, Jinyuan; Ouyang, Jun

doi:10.1097/brs.0000000000000644

Cited by 15 publications

(6 citation statements)

References 27 publications

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“…2B). Each specimen was fixed on the BoseAT-3510 with the axis of the screw perpendicular to the axis of the customdesigned vice 22 . Two kinds of fatigue testing were conducted, cycled at a rate of 2 Hz for 5000 cycles 23 and a rate of 2 Hz for 10,000 cycles 24 .…”

Section: Cyclic Fatigue Loading Testingmentioning

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: Cyclic Fatigue Loading Testingmentioning

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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“…Chen et al [19] applied finite element analysis (FEA) to verify that the overall biomechanical properties of ATPS fixation were superior to that of ordinary VBS fixation. Wu et al [4] performed a biomechanical test on 60 LCS specimens and compared the difference of pullout force between the ATPS fixation and ordinary VBS fixation before and after the fatigue tests. Furthermore, the vertebral screw canals were repaired and strengthened with bone cement, and then compared again.…”

Section: Biomechanical Studymentioning

confidence: 99%

“…However, in patients with poor bone conditions or who need multi-segmental decompression and reconstruction, it is often difficult for traditional anterior fixation to provide sufficient biomechanical stability, which may result in early internal fixation failure or bone graft non-fusion [3–5]. For patients with cervical osteoporosis, tuberculosis, or tumor invasion, the incidence of loosening, prolapse, and break of internal fixations after the traditional anterior cervical vertebral screw fixation is as high as 20% to 50% [4,5]. Moreover, for multi-segmental anterior cervical plate and screw fixation, the incidence of non-fusion can reach 20% to 50%, and the failure rate of internal fixations is also reported to be as high as 30% to 100% [6].…”

Section: Introductionmentioning

confidence: 99%

Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

Zhang

Gao

et al. 2019

Med Sci Monit

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The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.

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“…Thus far, ATPS has been studied by many scholars [9][10][11][12][13][14][15], but the safe range of ATPS is rarely discussed.…”

Section: Introductionmentioning

confidence: 99%

The research on safe range of the anterior transpedicular screw in lower cervical vertebrae

Zhang

Hou

et al. 2022

Preprint

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Objective: Exploring the safe range of anterior transpedicular screw (ATPS) in the lower cervical spine. Methods: Fifty healthy adult cervical spine CT imaging data were selected from our institution for this study. The image data was imported into Mimics 21.0 software in DICOM format for 3D model reconstruction. Then, using the intersection of the pedicle axis and the anterior wall of the vertebral body as the screw entry point, a 3.5 mm simulated screw was inserted. The simulated screw was rotated and moved with the intersection acting as its center. On the horizontal view, the included angle (α) between the simulated screw axis and the mid-sagittal plane, the width of the pedicle, and the distance between the transverse point and the mid-sagittal plane at the anterior vertebral body wall were measured from C3 to C7; On the sagittal view, the included angle (β) between the simulated screw axis and the plane of the anterior vertebral body wall, the height of pedicle, and the distance between the sagittal intersection point and the upper endplate were measured C3 to C7. Results: No matter in the transverse or sagittal planes, C7 had the largest average safety range, while C3 was the smallest. The average safety range of screw placement on the transverse plane increased from C3 to C7, ranging from 5.25°to 9.43°, of which C7 was the largest (9.43°) and C3 was the smallest (5.25°). The average safety range of screw placement on the sagittal plane showed a trend of first increasing, then decreasing, and then increasing, ranging from 12.57° to 14.70°, of which C7 was the largest (14.70°), and C3 was the smallest (12.57°). There was no statistical difference between the left and right pedicles of the same cervical level (P>0.05). Conclusions: When the entry point was determined, there was a certain safety range for ATPS in the lower cervical spine. Those are helpful for the clinical application of ATPS technology. However, the individual anatomy of the cervical spine is relatively different, and sufficient preoperative preparations should still be made to ensure the safety and accuracy of screw placement.

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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

Abstract: The findings of this study suggest that instant PPF and fatigue resistance capability of an ATPS fixation were significantly better than other control groups, especially in the osteoporotic vertebrae.

Cited by 15 publications

References 27 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

Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

The research on safe range of the anterior transpedicular screw in lower cervical vertebrae

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