Hans-Joachim Riesner1, Thomas R Blattert2, Renate Krezdorn3, Simone Schädler3, Hans-Joachim Wilke4. 1. German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. 2. Schwarzach Orthopedic Clinic·Spine Surgery & Traumatology, Dekan-Graf-Straße 2 - 6, 94374, Schwarzach, Germany. 3. Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University Hospital Ulm, Helmholtzstr. 14, 89081, Ulm, Germany. 4. Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University Hospital Ulm, Helmholtzstr. 14, 89081, Ulm, Germany. hans-joachim.wilke@uni-ulm.de.
Abstract
PURPOSE: In an osteoporotic vertebral body, cement-augmented pedicle screw fixation could possibly be optimized by the creation of an initial cavity. The aim of this study is to compare three test groups with regard to their loosening characteristics under cyclic loading. METHODS: Eighteen human, osteoporotic spine segments were divided in three groups. Flexibility tests and cyclic loading tests were performed with an internal fixator. The screws were fixed after creation a cavity and with cement (cavity-augmented group), without cavity and with cement (augmented group), and without cavity and without cement (control group). Cyclic loading up to 100,000 cycles was applied with a complex loading protocol. Screw loosening was measured with flexibility tests after implantation and after cyclic loading. Cement distribution was visualized from CT scans. RESULTS: In all groups, range of motion increased during cyclic loading, representing significant screw loosening after 100,000 cycles. In both augmented groups, screw loosening was less pronounced than in the control group. The cavity-augmented group showed only a slight tendency of screw loosening, but with smaller variations compared to both other groups. This may be explained with a trend for a more equal and homogeneous cement volume around each tip for the cavity-augmented group. CONCLUSION: This study demonstrated that creating a cavity may allow a more equal fixation of all pedicle screws with slight reduction of loosening. However, augmentation only through a cannulated screw is almost equivalent, if care is taken that enough cement volume can be pushed out around the tip of the screw.
PURPOSE: In an osteoporotic vertebral body, cement-augmented pedicle screw fixation could possibly be optimized by the creation of an initial cavity. The aim of this study is to compare three test groups with regard to their loosening characteristics under cyclic loading. METHODS: Eighteen human, osteoporotic spine segments were divided in three groups. Flexibility tests and cyclic loading tests were performed with an internal fixator. The screws were fixed after creation a cavity and with cement (cavity-augmented group), without cavity and with cement (augmented group), and without cavity and without cement (control group). Cyclic loading up to 100,000 cycles was applied with a complex loading protocol. Screw loosening was measured with flexibility tests after implantation and after cyclic loading. Cement distribution was visualized from CT scans. RESULTS: In all groups, range of motion increased during cyclic loading, representing significant screw loosening after 100,000 cycles. In both augmented groups, screw loosening was less pronounced than in the control group. The cavity-augmented group showed only a slight tendency of screw loosening, but with smaller variations compared to both other groups. This may be explained with a trend for a more equal and homogeneous cement volume around each tip for the cavity-augmented group. CONCLUSION: This study demonstrated that creating a cavity may allow a more equal fixation of all pedicle screws with slight reduction of loosening. However, augmentation only through a cannulated screw is almost equivalent, if care is taken that enough cement volume can be pushed out around the tip of the screw.
Authors: Lukas Weiser; Gerd Huber; Kay Sellenschloh; Lennart Viezens; Klaus Püschel; Michael M Morlock; Wolfgang Lehmann Journal: Eur Spine J Date: 2018-06-09 Impact factor: 3.134
Authors: Odysseas Paxinos; Parmenion P Tsitsopoulos; Michael R Zindrick; Leonard I Voronov; Mark A Lorenz; Robert M Havey; Avinash G Patwardhan Journal: J Neurosurg Spine Date: 2010-10