Pedicle screw augmentation with bone cement enforced Vicryl mesh.

Area of Science:

• Orthopaedic Research
• Biomaterials Engineering
• Spinal Surgery

Background:

• Securing pedicle screws in osteoporotic or previously operated bone presents significant challenges.
• Existing augmentation techniques, like different screw types or cement augmentation, often lead to complications and difficult revisions.
• There is a need for improved methods to enhance pedicle screw fixation while minimizing risks.

Purpose of the Study:

• To evaluate the efficacy of biocompatible textile materials (Vicryl mesh) combined with bone cement for augmenting pedicle screw pullout strength.
• To assess the impact of this technique on reducing cement extrusion.
• To compare the biomechanical performance of standard bone cement versus textile-reinforced bone cement.

Main Methods:

• A biomechanical trial involving pedicle screws augmented with standard bone cement (BC) or bone cement reinforced with Vicryl mesh (BCVM).
• Testing was conducted in osteoporosis-like saw bone blocks and human cadaveric lumbar vertebrae.
• Pullout testing was performed to measure screw fixation strength, and cement extrusion was monitored.

Main Results:

• In saw bone blocks, standard bone cement (BC) demonstrated significantly higher mean pullout force (350 N) than the BCVM technique (240 N).
• In cadaveric vertebrae, mean pullout forces were comparable between BC (784 N) and BCVM (757 N), with no statistical difference.
• Crucially, cement extrusion occurred in 40% of BC cases but was completely avoided with the BCVM technique.

Conclusions:

• Textile reinforcement of bone cement for pedicle screw augmentation effectively reduces cement extrusion compared to conventional methods.
• The BCVM technique provides reproducible mechanical strength, comparable to standard bone cement in cadaveric specimens.
• This approach offers a safer alternative for enhancing pedicle screw fixation in challenging bone conditions.