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Cortical bone trajectory for lumbar pedicle screws.

B G Santoni¹, R A Hynes, K C McGilvray

¹Orthopaedic Bioengineering Research Laboratory, School of Biomedical Engineering, Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523-1374, USA.

The Spine Journal : Official Journal of the North American Spine Society

|September 16, 2008

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A novel cortical bone trajectory for lumbar pedicle screws shows comparable pullout and toggle strength to traditional methods. This technique may offer improved fixation in patients with poor bone quality, warranting further clinical investigation.

Area of Science:

Orthopedic Surgery
Biomechanical Engineering
Spinal Fusion Techniques

Background:

Osteoporotic bone poses challenges for solid implant fixation in spinal surgery.
Novel pedicle screw trajectories, like the cortical bone trajectory, aim to enhance screw-bone purchase and minimize loosening.
Preliminary clinical data suggest comparable screw interference with the cortical bone trajectory, but biomechanical validation is lacking.

Purpose of the Study:

To biomechanically evaluate the mechanical competence of lumbar pedicle screws utilizing a cortical bone trajectory compared to traditional trajectories.
To assess the pullout strength and toggle resistance of screws inserted via the novel trajectory.

Main Methods:

A human cadaveric biomechanical study involving L1-L5 vertebral levels.

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Dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (qCT) for bone density assessment.

Uniaxial pullout and quasi-static toggle testing of pedicle screws inserted via traditional and cortical bone trajectories.

Main Results:

Cortical bone trajectory screws showed a trend towards a 30% increase in uniaxial yield pullout load (p=0.080).
No significant differences in construct stiffness or failure moments were observed between the two trajectories.
Pedicle screw fixation strength correlated positively with bone density (qCT) for both trajectories.

Conclusions:

The cortical bone trajectory demonstrates equivalent biomechanical performance (pullout and toggle) to the traditional trajectory for lumbar pedicle screws.
The observed trend of increased uniaxial pullout strength and association with higher bone density supports the use of cortical bone trajectory screws in patients with compromised bone quality.