Biomechanical properties of pedicle screw fixation augmented with allograft bone particles in osteoporotic vertebrae: different sizes and amounts

Jia, Chong-Yu; Zhang, Renjie; Xing, Tao; Gao, Hai; Li, Huimin; Dong, Fulong; Zhang, Jianxiang; Ge, Peng; Song, Peiwen; Xu, Peng; Zhang, Huaqing; Shen, Cailiang

doi:10.1016/j.spinee.2019.04.013

Cited by 18 publications

(28 citation statements)

References 37 publications

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“…Since 2016 augmentation with allograft bone particles has been applied in our clinic to increase pedicle screw fixation strength in patients with poor bone quality. The biomechanical study of similar technique give the evidence that augmentation with bone allograft particles provides a considerable increase in screw purchase strength in bone furthermore this study highlights benefits from pedicle augmentation [18]. In our study a slightly different modification is used as far as a greater hyperdense area is formed within a vertebral body that potentially strengthens pedicle screw fixation.…”

Section: Discussionmentioning

confidence: 80%

“…The source of the reported incongruences is that the most frequently used tests in biomechanical works were pullout tests. It has been proven that a pullout mechanism causes a tiny minority of cases with pedicle screw fixation instability while the most frequent is mediated by craniocaudal toggling under physiological loads [17,18]. According to the results of biomechanical tests, the effectiveness of PMMA augmentation is greater in terms of pullout resistance while the effect on performance in fatigue tests is lower [17,19].…”

Section: Discussionmentioning

confidence: 99%

“…Ventral shift of screw pivot point results in a different pattern of screw loosening -proximal loosening that is maximally presented in pedicles [12,21]. The way to overcome the discussed biomechanical drawback is augmentation of the whole screw trajectory including pedicles that is associated with an unacceptable risk if PMMA is used for augmentation [18].…”

Section: Discussionmentioning

confidence: 99%

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Pedicle Screw Fixation Applying Allogenic Bone Graft Augmentation in Patients with Severe Osteoporosis

Bokov¹

2020

OROAJ

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Objective: Objective of this study is to suggest an alternative to augmentation applying liquid substances and to study the results of pedicle screw fixation using allogeneic bone augmentation in patients with severe osteoporosis. Methods:A prospective non-randomized study of 22 patients with either unstable traumatic injuries of lumbar spine or thoracolumbar junction or spinal stenosis with unstable segments with Tcr by DXA below -3,5 and radiodensity below 80 HU. Patients were treated employing pedicle screw fixation with allogeneic bone augmentation. Minimal follow-up period accounted for 18 months. Cases with implant instability were registered and analyzed.Results: During the follow-up period CT signs of screw loosening were detected in 3. Out of those 2 patients presented with anterior or posterior fusion verified on CT therefore screw loosening was considered clinically insignificant. One patient presented with implant instability caused by wiper wind shield effect instability mechanism and revision pedicle screw was performed. The suggested technique provided favorable results in patients with severe osteoporosis with screw loosening detected on CT accounted for 13,6, 95% CI [2,9; 34,9] while clinically significant cases formed only 4,5%, 95% CI [0,2; 22,8]. Conclusion:Augmentation with allograft bone particles provides stability of pedicle screw fixation in patients with severe osteoporosis. The suggested augmentation technique can be an alternative to PMMA augmentation as far no liquids are used. An additional benefit of the suggested solution is that also pedicle augmentation is available.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pedicle Screw Fixation Applying Allogenic Bone Graft Augmentation in Patients with Severe Osteoporosis

Bokov¹

2020

OROAJ

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“…However, recently, Jia et al [15] reported that augmentation of the trajectory allograft bone using small-diameter cancellous bone particles via a delivery tube before screw insertion can significantly increase the pullout strength and allowed good distribution of the bone at the screw-bone interface. To improve the bone grafting technique, we used a small allograft of cancellous bone particles and changed the screw trajectory using larger-diameter screws.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous implantation of pedicle screws via a different trajectory: a minimally invasive surgical option for screw loosening in osteopenic or osteoporotic conditions

Yoo

Kim

et al. 2021

J Korean Soc Geriatr Neurosurg

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Posterior screwing with interbody fusion is commonly performed for the treatment of many different spine pathologies. Despite immediate and strong fixation, as well as a relatively few device-related complications, screw fixation for the purpose of bone fusion in the soteopenic or osteoporotic spine still remains a challenge [1,2]. A typical complication of pedicle screw fixation is screw loosening and the estimated rate ranges from 0.8% to 27%, and the incidence rate increases rapidly in cases of severe osteoporotic spine [3,4].In cases of symptomatic pedicle screw loosening unfortunately, few treatment options exist. The typical treatment is extensive Objective: The aim of this study was to evaluate the feasibility and safety of screw reimplantation via a different trajectory as a minimally invasive alternative to extensive open surgery for symptomatic low-grade screw loosening. Methods: Among patients who underwent single-level posterior lumbar interbody fusion and percutaneous screw fixation, a consecutive series of 10 patients in whom percutaneous screw reimplantation was performed via a different trajectory due to pedicle screw loosening were included in this study. Pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with radiolucent halo zones at a vertebral level. All patients were treated via a posterior approach with removal of the loosened screws and augmentation of the allograft bone chips, followed by reimplantation with a different downward and medial trajectory using a larger-diameter screw. Demographic, preoperative, and postoperative data were collected and analyzed. Results: The loosened screws could be removed without difficulty, and reimplantation was successfully performed via a new trajectory with larger screws in all patients. All patients reported significant pain relief at the final follow-up. Moreover, no severe complications, such as wound infection or repeated screw loosening, were observed during the follow-up period. Conclusion: Percutaneous reimplantation of screws via a different trajectory for pedicle screw loosening with larger screws can be safely attempted in selected patients to relieve pain and avoid extensive long-level screw fixation.

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“…Therefore, there is a strong demand for the improvement of internal fixation in osteoporotic bones. In the past few decades, there has been considerable progress in improving the stability of internal fixation, mainly in the optimization of materials, bone and screw interface enhancement, and the improvement of surgical techniques (4)(5)(6)(7)(8). However, the ideal measure is to enhance the quality and quantity of osteoporotic bones, that is, to improve bone density, increase the volume of cortical bone and cancellous bone, increase bone strength, and reduce the rate of osteoporotic fractures and internal fixation failures.…”

Section: Introductionmentioning

confidence: 99%

Effect of combined treatment with pulsed electromagnetic field stimulation and sclerostin monoclonal antibody on changes in bone metabolism and pedicle screw augmentation in rabbits with ovariectomy-induced osteoporosis

Qian¹,

Wang²,

Dong³

et al. 2021

Ann Palliat Med

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Background: Both pulsed electromagnetic field (PEMF) stimulation and sclerostin monoclonal antibody are useful for treating osteoporosis, but whether the two therapies have synergistic effects on both screw fixation quality and bone metabolism of ovariectomy-induced osteoporosis has not been reported.Methods: We used ovariectomy to create a rabbit model of postmenopausal osteoporosis. Then, specimens were fixed with pedicle screws in the L4 vertebral body. Rabbits were randomly divided into an OVX control group, PEMF group, Scl-Ab group, and PEMF+Scl-Ab group. The PEMF group was given PEMF magnetic therapy, the Scl-Ab group was administered a subcutaneous Scl-Ab injection, and the PEMF+Scl-Ab group received both therapies. The OVX group was injected subcutaneously with the same dose of saline instead. After eight weeks of treatment, the bone metabolism index, bone mineral density (BMD), and bone microstructural, biological, and biomechanical parameters were evaluated.Results: BMD significantly decreased six months post-ovariectomy. Compared with that of the OVX group, the BMD of the PEMF, Scl-Ab, and PEMF+Scl-Ab groups increased by 20.3%, 19.9%, and 35.0%, respectively. The maximum pulling force of pedicle screws increased by 14.0%,15.0% and 19.1%, and the maximum failure power consumption of pedicle screws increased by 27.9%, 27.2% and 33.6%, respectively; these differences were statistically significant (P<0.05). The bone metabolism index and bone microstructure parameters of the PEMF+Scl-Ab group were more optimal than those in the single treatment group.Conclusions: Both Scl-Ab and PEMF therapy can enhance the BMD and the mechanical strength of pedicle screws in osteoporotic bones of rabbits with postmenopausal osteoporosis. However, combination of the two measures has achieved even better results, yielding potential clinical application value.

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Biomechanical properties of pedicle screw fixation augmented with allograft bone particles in osteoporotic vertebrae: different sizes and amounts

Cited by 18 publications

References 37 publications

Pedicle Screw Fixation Applying Allogenic Bone Graft Augmentation in Patients with Severe Osteoporosis

Pedicle Screw Fixation Applying Allogenic Bone Graft Augmentation in Patients with Severe Osteoporosis

Percutaneous implantation of pedicle screws via a different trajectory: a minimally invasive surgical option for screw loosening in osteopenic or osteoporotic conditions

Effect of combined treatment with pulsed electromagnetic field stimulation and sclerostin monoclonal antibody on changes in bone metabolism and pedicle screw augmentation in rabbits with ovariectomy-induced osteoporosis

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