A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation

被引:133
作者
Frankel, Bruce M. [1 ]
D'Agostino, Sabino [1 ]
Wang, Chiang [1 ]
机构
[1] Med Univ S Carolina, Dept Neurosurg, Charleston, SC 29425 USA
关键词
biomechanical analysis; osteoporosis; pedicle screw augmentation; polymethylmethacrylate; spinal fracture;
D O I
10.3171/SPI-07/07/047
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Instrumentation of the osteoporotic spine can be fraught with complications such as hardware failure. A cadaver study was performed to determine the biomechanical performance of polymethylmethacrylate (PMMA)-augmented pedicle screws. Methods. Three osteoporotic human cadaveric specimens with a mean bone mineral density of 0.70 g/cm(2) were used to evaluate the performance of a novel fenestrated bone tap in pedicle screw augmentation. On this device, tap threads serve a dual purpose in preventing backflow of cement toward neural elements while allowing for a custom form for subsequent screw placement. The tap was used to inject a mean volume of 3.7 ml PMMA/pedicle (range 2-8.0 ml PMMA/pedicle) followed by pedicle screw placement between L-5 and T-5, alternating between augmented and nonaugmented instrumentation. Axial pullout testing was then performed. Results. Pedicle screw pullout strength was increased in both primary and salvage procedures by 119% (p = 0.001) and 162% (p = 0.01), respectively, after PMMA augmentation. Additionally, the injected cement volumes were divided into two groups, a low-cement group (<= 2.8 ml/pedicle) and a high-cement group (>= 5.5 ml/pedicle). Interestingly, the Pullout strength did not significantly change with increased cement usage between the two groups (p > 0.05 for all comparisons). Conclusions. Polymethylmethacrylate-augmented pedicle screw fixation results in a significant increase in the axial pullout strength of augmented pedicle screws in both primary and revision procedures. This technique may be a valuable adjunct in cases in which bolstering of the screw-bone interface is necessary.
引用
收藏
页码:47 / 53
页数:7
相关论文
共 19 条
[1]  
Bartonicek J, 1994, Acta Chir Orthop Traumatol Cech, V61, P48
[2]   USE OF POLYMETHYLMETHACRYLATE TO ENHANCE SCREW FIXATION IN BONE [J].
CAMERON, HU ;
JACOB, R ;
MACNAB, I ;
PILLIAR, RM .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1975, 57 (05) :655-656
[3]   Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design [J].
Cook, SD ;
Salkeld, SL ;
Whitecloud, TS ;
Barbera, J .
JOURNAL OF SPINAL DISORDERS, 2000, 13 (03) :230-236
[4]   A biomechanical comparison of facet screw fixation and pedicle screw fixation - Effects of short-term and long-term repetitive cycling [J].
Ferrara, LA ;
Secor, JL ;
Jin, BH ;
Wakefield, A ;
Inceoglu, S ;
Benzel, EC .
SPINE, 2003, 28 (12) :1226-1234
[5]   PULLOUT STRENGTH OF FIXATION SCREWS FROM POLYMETHYLMETHACRYLATE BONE-CEMENT [J].
FLAHIFF, CM ;
GOBER, GA ;
NICHOLAS, RW .
BIOMATERIALS, 1995, 16 (07) :533-536
[6]   EFFECTS OF BONE-MINERAL DENSITY ON PEDICLE SCREW FIXATION [J].
HALVORSON, TL ;
KELLEY, LA ;
THOMAS, KA ;
WHITECLOUD, TS ;
COOK, SD .
SPINE, 1994, 19 (21) :2415-2420
[7]  
Hernigou P, 1996, J SPINAL DISORD, V9, P322
[8]  
Ignatius A, 2001, J BIOMED MATER RES, V58, P254, DOI 10.1002/1097-4636(2001)58:3<254::AID-JBM1014>3.3.CO
[9]  
2-1
[10]   Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors - Technical note [J].
Jang, JS ;
Lee, SH ;
Rhee, CH ;
Lee, SH .
JOURNAL OF NEUROSURGERY, 2002, 96 (01) :131-134