Sacral Endplate Penetrating Screw for Lumbosacral Fixation: A Cadaveric Biomechanical Study

被引:7
作者
Grigoryan, Grigor [1 ]
Inceoglu, Serkan [1 ]
Danisa, Olumide A. [1 ,2 ]
Cheng, Wayne [1 ]
机构
[1] Loma Linda Univ, Dept Orthoped Surg, Loma Linda, CA 92350 USA
[2] Loma Linda Univ, Dept Neurol Surg, Loma Linda, CA 92350 USA
关键词
Cortical bone trajectory; Lumbosacral fusion; Sacral endplate penetrating screw; Sacrum instrumentation; S1-Alar SCREW; Osteoporotic bone; LUMBAR INTERBODY FUSION; PEDICLE SCREW; PLACEMENT; SCOLIOSIS; DENSITY;
D O I
10.1093/ons/opy388
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Cortical bone trajectory is a relatively new alternative for instrumentation of the lumbar spine. When performing lumbosacral instrumentation, a novel S1 endplate penetrating screw (EPS) has been recently shown to have higher insertional torque than the traditional trajectory screw, but the biomechanical properties of this new trajectory are yet to be verified with the cadaveric studies. OBJECTIVE: To evaluate 2 screw trajectories in sacra using cyclic loading and pullout tests, and to determine whether bone quality had different effects on the 2 trajectories. METHODS: Nine cadaveric sacra were used, 5 of which had normal bone mineral density (BMD) and 4 were osteoporotic. Each side of the sacra was randomly assigned to either EPS trajectory or S1-alar screw (S1AS) trajectory. Each screw then underwent cyclic loading followed by pullout force measurement. A mixed-design 2 way ANOVA test was used to detect differences between the groups. RESULTS: The EPS group had less relative rotation at the bone-screw interface during cyclic loading than the S1AS group (P = .016) regardless of bone quality. The pullout force following the cyclic loading was significantly higher in the EPS group (2349 +/- 838 N) than the S1AS group (917 +/- 909 N) in normal bone (P < .0001). The difference was more pronounced in osteoporotic bone with the EPS (1075 +/- 216 N) compared to the S1AS (365 +/- 422 N; P < .0001). CONCLUSION: The S1 EPS trajectory is significantly more stable against loosening and has a higher pullout force compared to the S1AS trajectory. The difference between the 2 trajectories is more pronounced in osteoporotic bone.
引用
收藏
页码:396 / 402
页数:7
相关论文
共 25 条
[11]   Advantage of pedicle screw fixation directed into the apex of the sacral promontory over bicortical fixation - A biomechanical analysis [J].
Lehman, RA ;
Kuklo, TR ;
Belmont, PJ ;
Andersen, RC ;
Polly, DW .
SPINE, 2002, 27 (08) :806-811
[12]   Stronger bicortical sacral pedicle screw fixation through the S1 Endplate -: An in vitro cyclic loading and pull-out force evaluation [J].
Luk, KDK ;
Chen, L ;
Lu, WW .
SPINE, 2005, 30 (05) :525-529
[13]   Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique [J].
Matsukawa, Keitaro ;
Yato, Yoshiyuki ;
Kato, Takashi ;
Imabayashi, Hideaki ;
Asazuma, Takashi ;
Nemoto, Koichi .
JOURNAL OF NEUROSURGERY-SPINE, 2014, 21 (02) :203-209
[14]  
Mirkovic S, 1990, SPINE PHILA PA 197 S, V16, pS289
[15]  
OGILVIE JW, 1986, CLIN ORTHOP RELAT R, P120
[16]   Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases [J].
Park, Ye-Soo ;
Kim, Hong-Sik ;
Baek, Seung-Wook ;
Lee, Sang-Hyun .
CLINICS IN ORTHOPEDIC SURGERY, 2013, 5 (03) :225-229
[17]   SACRAL SCREW LOADS IN LUMBOSACRAL FIXATION FOR SPINAL DEFORMITY [J].
PASHMAN, RS ;
HU, SS ;
SCHENDEL, MJ ;
BRADFORD, DS .
SPINE, 1993, 18 (16) :2465-2470
[18]   Cortical Bone Trajectory for Lumbar Pedicle Screw Placement: A Review of Published Reports [J].
Phan, Kevin ;
Hogan, Jarred ;
Maharaj, Monish ;
Mobbs, Ralph J. .
ORTHOPAEDIC SURGERY, 2015, 7 (03) :213-221
[19]  
Robertson PA, 1999, J SPINAL DISORD, V12, P227
[20]   Cortical bone trajectory for lumbar pedicle screws [J].
Santoni, B. G. ;
Hynes, R. A. ;
McGilvray, K. C. ;
Rodriguez-Canessa, G. ;
Lyons, A. S. ;
Henson, M. A. W. ;
Womack, W. J. ;
Puttlitz, C. M. .
SPINE JOURNAL, 2009, 9 (05) :366-373