Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.