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A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
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Probing and Tapping: Are We Inserting Pedicle Screws Correctly?

Vishal Prasad1, Addisu Mesfin2, Robert Lee3

  • 1Medway Maritime Hospital, NHS Foundation Trust, Gillingham, Kent, United Kingdom.

Spine Deformity
|December 9, 2016
PubMed
Summary

Optimizing pilot hole size is crucial for pedicle screw fixation strength, as both too large and too small holes significantly reduce pullout strength. Tapping should be done cautiously to avoid compromising screw stability.

Keywords:
Pilot holePolyurethane foamProbe holeScrew pulloutTapping

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Area of Science:

  • Biomechanical Engineering
  • Spinal Surgery
  • Materials Science

Background:

  • Pedicle screw fixation is critical in spinal surgery, but failure, especially in osteoporotic bone, can lead to revision surgery and complications.
  • Understanding the mechanical properties of the screw-bone interface is essential for improving fixation stability.

Purpose of the Study:

  • To quantify the mechanical strength of the foam-screw interface by evaluating the impact of probe/pilot hole diameter and tap sizes.
  • To identify optimal parameters for pedicle screw insertion to enhance fixation strength and minimize failure risk.

Main Methods:

  • Utilized reference-grade polyurethane foam (0.16, 0.24, 0.32 g/cm³ densities) to simulate bone.
  • Tested various pilot hole diameters (1.5-6.0 mm) and tap sizes (no tap, 3.5-6.5 mm) with 6.5 × 45-mm pedicle screws.
  • Measured pullout strength through axial pulling in statistically relevant sample sizes (n=720 for pilot holes, n=300 for taps).

Main Results:

  • Pilot hole diameter exhibited a nonlinear, parabolic effect on pullout strength, indicating an optimal size.
  • Both excessively large and small pilot holes resulted in a rapid decrease in pullout strength.
  • Tapping with sizes close to the screw diameter led to an exponential falloff in pullout strength, while undertapping had minimal impact.

Conclusions:

  • An ideal pilot hole size is approximately half the diameter of the pedicle screw.
  • If tapping is necessary, using a tap two sizes smaller than the screw is recommended.
  • Clinical application requires consideration of bone quality, as optimal parameters may differ from foam models.