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Article: Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition

TitleBiomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition
Authors
Keywordsbiomechanics
lumbosacral fusion
osteoporosis
polymethylmethacrylate
sacral pediclescrew
Issue Date2010
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.com
Citation
Journal Of Spinal Disorders And Techniques, 2010, v. 23 n. 6, p. 404-409 How to Cite?
AbstractObjectives: To compare the subsidence displacement after cyclic loading among 4 sacral pedicle screw fixations of bicortical, tricortical, standard polymethylmethacrylate (PMMA) augmentation, and sub-endplate PMMA augmentation in osteoporotic condition. Summary of background data: Implant failure caused by screw loosening is a clinical problem for lumbosacral fusions, especially in osteoporotic patients. To improve sacral screw anchoring strength, the main fixation techniques need to be evaluated biomechanically. Methods: For this study, 11 fresh osteoporotic cadaver sacra were harvested and bone mineral density was measured with dual-energy radiograph absorptiometry. A 7mm diameter monoaxial pedicle screw (S1) was randomly assigned by side (left vs. right) and placed bicortically or tricortically. The 2 screws, followed 2000 cyclic compression loading of 30 to 250N, were removed. The screw tracts were filled up with PMMA, then, screws 5mm shorter than the bicortical or tricortical fixation were reinserted (defined as standard and sub-endplate PMMA augmented sacral screw fixations, respectively). The PMMA augmented screws were then retested as before. Screw subsidence displacement after 2000 cyclic loading was measured and compared. Results: The average bone mineral density of 11 specimens was 0.71g/cm, ranged from 0.65 to 0.78g/cm. No significant difference of subsidence displacement was detected between tricortical and standard PMMA augmented screws (P>0.05), however, the 2 fixations exhibited markedly less subsidence than bicortical screw (P<0.05). Sub-endplate PMMA augmented screw showed the least subsidence among all the screws (P<0.05). Conclusions: PMMA augmentation can increase the bonding strength of sacral screw-bone interface and the sub-endplate PMMA augmented sacral screw could obtain the highest stability among the 4 fixation techniques in osteoporotic condition. © 2010 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/125175
ISSN
2015 Impact Factor: 2.291
2015 SCImago Journal Rankings: 0.798
ISI Accession Number ID
Funding AgencyGrant Number
HKRGC715306/06E
GDSTC2008B050100012
Funding Information:

Partial support received from HKRGC (715306/06E) and GDSTC (2008B050100012).

References

 

DC FieldValueLanguage
dc.contributor.authorYu, BSen_HK
dc.contributor.authorZhuang, XMen_HK
dc.contributor.authorZheng, ZMen_HK
dc.contributor.authorZhang, JFen_HK
dc.contributor.authorLi, ZMen_HK
dc.contributor.authorLu, WWen_HK
dc.date.accessioned2010-10-31T11:15:42Z-
dc.date.available2010-10-31T11:15:42Z-
dc.date.issued2010en_HK
dc.identifier.citationJournal Of Spinal Disorders And Techniques, 2010, v. 23 n. 6, p. 404-409en_HK
dc.identifier.issn1536-0652en_HK
dc.identifier.urihttp://hdl.handle.net/10722/125175-
dc.description.abstractObjectives: To compare the subsidence displacement after cyclic loading among 4 sacral pedicle screw fixations of bicortical, tricortical, standard polymethylmethacrylate (PMMA) augmentation, and sub-endplate PMMA augmentation in osteoporotic condition. Summary of background data: Implant failure caused by screw loosening is a clinical problem for lumbosacral fusions, especially in osteoporotic patients. To improve sacral screw anchoring strength, the main fixation techniques need to be evaluated biomechanically. Methods: For this study, 11 fresh osteoporotic cadaver sacra were harvested and bone mineral density was measured with dual-energy radiograph absorptiometry. A 7mm diameter monoaxial pedicle screw (S1) was randomly assigned by side (left vs. right) and placed bicortically or tricortically. The 2 screws, followed 2000 cyclic compression loading of 30 to 250N, were removed. The screw tracts were filled up with PMMA, then, screws 5mm shorter than the bicortical or tricortical fixation were reinserted (defined as standard and sub-endplate PMMA augmented sacral screw fixations, respectively). The PMMA augmented screws were then retested as before. Screw subsidence displacement after 2000 cyclic loading was measured and compared. Results: The average bone mineral density of 11 specimens was 0.71g/cm, ranged from 0.65 to 0.78g/cm. No significant difference of subsidence displacement was detected between tricortical and standard PMMA augmented screws (P>0.05), however, the 2 fixations exhibited markedly less subsidence than bicortical screw (P<0.05). Sub-endplate PMMA augmented screw showed the least subsidence among all the screws (P<0.05). Conclusions: PMMA augmentation can increase the bonding strength of sacral screw-bone interface and the sub-endplate PMMA augmented sacral screw could obtain the highest stability among the 4 fixation techniques in osteoporotic condition. © 2010 by Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.comen_HK
dc.relation.ispartofJournal of Spinal Disorders and Techniquesen_HK
dc.subjectbiomechanicsen_HK
dc.subjectlumbosacral fusionen_HK
dc.subjectosteoporosisen_HK
dc.subjectpolymethylmethacrylateen_HK
dc.subjectsacral pediclescrewen_HK
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshOsteoporosis - physiopathology - surgery-
dc.subject.meshSacrum - physiopathology - surgery-
dc.subject.meshSpinal Fusion - instrumentation - methods-
dc.titleBiomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic conditionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1536-0652&volume=23&issue=6&spage=404&epage=409&date=2010&atitle=Biomechanical+comparison+of+4+fixation+techniques+of+sacral+pedicle+screw+in+osteoporotic+conditionen_HK
dc.identifier.emailLu, WW:wwlu@hku.hken_HK
dc.identifier.authorityLu, WW=rp00411en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BSD.0b013e3181b63f4den_HK
dc.identifier.pmid20087222-
dc.identifier.scopuseid_2-s2.0-77955459474en_HK
dc.identifier.hkuros180220en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77955459474&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume23en_HK
dc.identifier.issue6en_HK
dc.identifier.spage404en_HK
dc.identifier.epage409en_HK
dc.identifier.isiWOS:000280575000008-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridYu, BS=25633299000en_HK
dc.identifier.scopusauthoridZhuang, XM=35436325900en_HK
dc.identifier.scopusauthoridZheng, ZM=7403007434en_HK
dc.identifier.scopusauthoridZhang, JF=35098035200en_HK
dc.identifier.scopusauthoridLi, ZM=36168413000en_HK
dc.identifier.scopusauthoridLu, WW=7404215221en_HK

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