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Article: Which is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell

TitleWhich is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell
Authors
Issue Date2011
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.com
Citation
Journal Of Spinal Disorders And Techniques, 2011, v. 24 n. 6, p. E49-E56 How to Cite?
AbstractStudy Design: An in vitro biomechanical cadaver study. Objectives: To evaluate the pull-out strength after 5000 cyclic loading among 4 revision techniques for the loosened iliac screw using corticocancellous bone, longer screw, traditional cement augmentation, and boring cement augmentation. Summary of Background Data: Iliac screw loosening is still a clinical problem for lumbo-iliac fusion. Although many revision techniques using corticocancellous bone, larger screw, and polymethylmethacrylate (PMMA) augmentation were applied in repairing pedicle screw loosening, their biomechanical effects on the loosened iliac screw remain undetermined. Methods: Eight fresh human cadaver pelvises with the bone mineral density values ranging from 0.83 to 0.97 g/cm 2 were adopted in this study. After testing the primary screw of 7.5 mm diameter and 70 mm length, 4 revision techniques were sequentially established and tested on the same pelvis as follows: corticocancellous bone, longer screw with 100 mm length, traditional PMMA augmentation, and boring PMMA augmentation. The difference of the boring technique from traditional PMMA augmentation is that PMMA was injected into the screw tract through 3 boring holes of outer cortical shell without removing the screw. On an MTS machine, after 5000 cyclic compressive loading of -200∼-500 N to the screw head, axial maximum pull-out strengths of the 5 screws were measured and analyzed. Results: The pull-out strengths of the primary screw and 4 revised screws with corticocancellous bone, longer screw and traditional and boring PMMA augmentation were 1167 N, 361 N, 854 N, 1954 N, and 1820 N, respectively. Although longer screw method obtained significantly higher pull-out strength than corticocancellous bone (P<0.05), the revised screws using these 2 techniques exhibited notably lower pull-out strength than the primary screw and 2 PMMA-augmented screws (P<0.05). Either traditional or boring PMMA screw showed obviously higher pull-out strength than the primary screw (P<0.05); however, no significant difference of pull-out strength was detected between the 2 PMMA screws (P>0.05). Conclusions: Wadding corticocancellous bone and increasing screw length failed to provide sufficient anchoring strength for a loosened iliac screw; however, both traditional and boring PMMA-augmented techniques could effectively increase the fixation strength. On the basis of the viewpoint of minimal invasion, the boring PMMA augmentation may serve as a suitable salvage technique for iliac screw loosening. Copyright © 2011 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/170180
ISSN
2015 Impact Factor: 2.291
2015 SCImago Journal Rankings: 0.798
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorYu, BSen_US
dc.contributor.authorYang, ZKen_US
dc.contributor.authorLi, ZMen_US
dc.contributor.authorZeng, LWen_US
dc.contributor.authorWang, LBen_US
dc.contributor.authorLu, WWen_US
dc.date.accessioned2012-10-30T06:05:52Z-
dc.date.available2012-10-30T06:05:52Z-
dc.date.issued2011en_US
dc.identifier.citationJournal Of Spinal Disorders And Techniques, 2011, v. 24 n. 6, p. E49-E56en_US
dc.identifier.issn1536-0652en_US
dc.identifier.urihttp://hdl.handle.net/10722/170180-
dc.description.abstractStudy Design: An in vitro biomechanical cadaver study. Objectives: To evaluate the pull-out strength after 5000 cyclic loading among 4 revision techniques for the loosened iliac screw using corticocancellous bone, longer screw, traditional cement augmentation, and boring cement augmentation. Summary of Background Data: Iliac screw loosening is still a clinical problem for lumbo-iliac fusion. Although many revision techniques using corticocancellous bone, larger screw, and polymethylmethacrylate (PMMA) augmentation were applied in repairing pedicle screw loosening, their biomechanical effects on the loosened iliac screw remain undetermined. Methods: Eight fresh human cadaver pelvises with the bone mineral density values ranging from 0.83 to 0.97 g/cm 2 were adopted in this study. After testing the primary screw of 7.5 mm diameter and 70 mm length, 4 revision techniques were sequentially established and tested on the same pelvis as follows: corticocancellous bone, longer screw with 100 mm length, traditional PMMA augmentation, and boring PMMA augmentation. The difference of the boring technique from traditional PMMA augmentation is that PMMA was injected into the screw tract through 3 boring holes of outer cortical shell without removing the screw. On an MTS machine, after 5000 cyclic compressive loading of -200∼-500 N to the screw head, axial maximum pull-out strengths of the 5 screws were measured and analyzed. Results: The pull-out strengths of the primary screw and 4 revised screws with corticocancellous bone, longer screw and traditional and boring PMMA augmentation were 1167 N, 361 N, 854 N, 1954 N, and 1820 N, respectively. Although longer screw method obtained significantly higher pull-out strength than corticocancellous bone (P<0.05), the revised screws using these 2 techniques exhibited notably lower pull-out strength than the primary screw and 2 PMMA-augmented screws (P<0.05). Either traditional or boring PMMA screw showed obviously higher pull-out strength than the primary screw (P<0.05); however, no significant difference of pull-out strength was detected between the 2 PMMA screws (P>0.05). Conclusions: Wadding corticocancellous bone and increasing screw length failed to provide sufficient anchoring strength for a loosened iliac screw; however, both traditional and boring PMMA-augmented techniques could effectively increase the fixation strength. On the basis of the viewpoint of minimal invasion, the boring PMMA augmentation may serve as a suitable salvage technique for iliac screw loosening. Copyright © 2011 by Lippincott Williams & Wilkins.en_US
dc.languageengen_US
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.comen_US
dc.relation.ispartofJournal of Spinal Disorders and Techniquesen_US
dc.subject.meshAgeden_US
dc.subject.meshBiomechanicsen_US
dc.subject.meshBone Cementsen_US
dc.subject.meshBone Screwsen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshIlium - Surgeryen_US
dc.subject.meshInternal Fixatorsen_US
dc.subject.meshLumbar Vertebrae - Surgeryen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshProsthesis Failureen_US
dc.subject.meshReoperationen_US
dc.titleWhich is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shellen_US
dc.typeArticleen_US
dc.identifier.emailLu, WW:wwlu@hku.hken_US
dc.identifier.authorityLu, WW=rp00411en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/BSD.0b013e318224e55aen_US
dc.identifier.pmid21685804-
dc.identifier.scopuseid_2-s2.0-80051730950en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-80051730950&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume24en_US
dc.identifier.issue6en_US
dc.identifier.spageE49en_US
dc.identifier.epageE56en_US
dc.identifier.isiWOS:000293173600001-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridYu, BS=25633299000en_US
dc.identifier.scopusauthoridYang, ZK=49561886400en_US
dc.identifier.scopusauthoridLi, ZM=36168413000en_US
dc.identifier.scopusauthoridZeng, LW=42561936200en_US
dc.identifier.scopusauthoridWang, LB=42562124400en_US
dc.identifier.scopusauthoridLu, WW=7404215221en_US

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