Effects of hole preparation on screw pullout resistance and insertional torque: a biomechanical study

The authors conducted a study to assess the effect of a pilot hole preparation on screw pullout resistance and screw insertional torque.

Three different screws were tested: cancellous lateral mass screws, cortical lateral mass screws, and pedicle screws. Synthetic bone blocks were used as the host material. Each screw group was separated into two subgroups. The first subgroup of screws was inserted into the test material following pilot hole preparation. Pilot holes were prepared; a drill bit diameter size smaller than the core diameter of the screws was used. The second group of screws was inserted into the test material without pilot hole preparation (a 3- or 4-mm hole drilled for entrance site preparation only). The insertional torque was measured as the screw was advanced into the material. The screws were axially extracted from the host material at a constant speed of 2.5 mm/minute. The pullout resistances and insertional torques for the pilot hole and the nonpilot hole groups were then statistically compared. The authors found that preparation of a pilot hole caused a significant decrease in the insertional torque. The screws inserted without a pilot hole showed greater pullout resistances compared with those inserted following a pilot hole preparation; however, there was no statistically significant difference.

The optimum screw insertion technique may involve drilling a short pilot hole and using a drill bit with a smaller diameter than the screw core diameter to increase bone-screw purchase. This applies to cancellous and cortical lateral mass screws as well as pedicle screws.