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Calcium Triglyceride Versus Polymethylmethacrylate Augmentation: A Biomechanical Analysis of Pullout Strength
Lindsay E Hickerson1, John R Owen1, Jennifer S Wayne1
1Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and of Biomedical Engineering, Virginia Commonwealth University, McGuire Annex, 1112 East Clay St., Richmond, VA 23298, USA.
Spine Deformity
|December 9, 2016
Summary
Calcium triglyceride (CTG) augmentation significantly enhances pedicle screw pullout strength compared to polymethylmethacrylate (PMMA) in both primary and revision spinal surgery models.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Spinal fusion techniques
Background:
- Polymethylmethacrylate (PMMA) is the current standard for pedicle screw augmentation in osteoporotic spines.
- Calcium triglyceride (CTG) is a novel bone augmentation material with reported biocompatibility advantages over PMMA.
Purpose of the Study:
- To compare the biomechanical performance of CTG versus PMMA for pedicle screw augmentation.
- To evaluate performance in both primary and revision spinal models using a standardized pullout test.
Main Methods:
- A biomechanical pullout study was conducted using polyurethane foam blocks simulating osteoporotic bone.
- Pedicle screws were augmented with either PMMA or CTG, or left unaugmented, and subjected to pullout testing.
- Revision models were created by augmenting previously tested screws.
Main Results:
- CTG augmentation demonstrated significantly higher mean pullout strength than PMMA in both primary (1841.6 N vs 1218.1 N) and revision models (2513.0 N vs 1939.2 N).
- Both PMMA and CTG significantly increased construct stiffness compared to unaugmented controls, with no significant difference between the two augmentation materials.
- Statistical analysis confirmed significant differences in pullout strength for both primary (p < .0001) and revision (p < .0003) models.
Conclusions:
- Calcium triglyceride (CTG) augmentation provides superior axial pullout strength for pedicle screws compared to polymethylmethacrylate (PMMA).
- CTG represents a promising alternative for bone augmentation in spinal surgery, particularly in osteoporotic patients.
