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Can cavity-based pedicle screw augmentation decrease screw loosening? A biomechanical in vitro study.

Hans-Joachim Riesner1, Thomas R Blattert2, Renate Krezdorn3

  • 1German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|December 23, 2020
PubMed
Summary
This summary is machine-generated.

Creating a cavity before cement augmentation in osteoporotic vertebral bodies slightly reduced pedicle screw loosening under cyclic loading. Augmentation alone also improved fixation, suggesting effective cement distribution is key for stable spinal implants.

Keywords:
Cement augmentationCyclic testingIn vitro experimentOsteoporotic spinePedicle screw loosening

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Area of Science:

  • Spine Surgery
  • Biomechanical Engineering
  • Orthopedic Research

Background:

  • Osteoporotic vertebral bodies are prone to pedicle screw loosening.
  • Optimizing cement augmentation techniques is crucial for stable spinal fixation.

Purpose of the Study:

  • To compare screw loosening characteristics under cyclic loading in three groups: cavity-augmented, augmented, and control.
  • To evaluate the effect of pre-creating a cavity on cement-augmented pedicle screw fixation in osteoporotic spines.

Main Methods:

  • Eighteen human osteoporotic spine segments were tested.
  • Three groups: cavity-augmented, augmented (cement only), and control (no cement).
  • Cyclic loading (100,000 cycles) and flexibility tests were used to measure screw loosening; CT scans visualized cement distribution.

Main Results:

  • All groups showed screw loosening after cyclic loading.
  • Both augmented groups exhibited less loosening than the control group.
  • The cavity-augmented group showed the least loosening, with more homogeneous cement distribution.

Conclusions:

  • Creating a cavity before cement augmentation may enhance pedicle screw fixation and reduce loosening.
  • Cement augmentation, even without a pre-created cavity, significantly improves fixation.
  • Ensuring adequate cement volume around the screw tip is critical for stable fixation in augmented pedicle screws.