Minimizing Pedicle Screw Pullout Risks: A Detailed Biomechanical Analysis of Screw Design and Placement

Clinical Spine Surgery

Volumn 30, Issue 3, 2017, Pages E226-E232

  Bianco, Rohan Jean ^a,b,c   Arnoux, Pierre Jean ^c   Wagnac, Eric ^a,c   Mac Thiong, Jean Marc ^b,d,e   Aubin, Carl Éric ^a,b,d  

^a ÉCOLE POLYTECHNIQUE DE MONTRÉAL   (Canada)

^b UNIVERSITY OF MONTREAL   (Canada)

^c UMRT24 INRETS University of Mediterranée   (France)

^d UNIVERSITÉ DE MONTRÉAL   (Canada)

^e HÔPITAL DU SACRÉ COEUR DE MONTRÉAL   (Canada)

Author keywords

finite element analysis; pedicle screw; pullout test; spinal instrumentation

Indexed keywords

ANALYTICAL PARAMETERS; ARTICLE; BIOMECHANICS; BONE STRUCTURE; COMPUTER ASSISTED TOMOGRAPHY; CONTROLLED STUDY; CORTICAL BONE; EXPERIMENTAL DESIGN; FINITE ELEMENT ANALYSIS; LOAD CARRYING CAPACITY; MODEL; PEDICLE SCREW; PEDICLE SCREW FIXATION DEVICE; SCREW ANCHORAGE; SCREW DIAMETER; SCREW TRAJECTORY; SIMULATION; STRESS; TENSILE STRENGTH; DEVICES; HUMAN; IN VITRO STUDY; LUMBAR VERTEBRA; MATERIALS TESTING; PHYSIOLOGY; PROCEDURES; SPINE FUSION; SURGERY;

BIOMECHANICAL PHENOMENA; HUMANS; IN VITRO TECHNIQUES; LUMBAR VERTEBRAE; MATERIALS TESTING; PEDICLE SCREWS; SPINAL FUSION;

EID: 85016116893     PISSN: 23800186     EISSN: 23800194     Source Type: Journal    
DOI: 10.1097/BSD.0000000000000151     Document Type: Article

References (35)

1. Lenke LG, Kuklo TR, Ondra S, et al. Rationale behind the current state-of-The-art treatment of scoliosis (in the pedicle screw era). Spine. 2008;33:1051-1054.
2. Dhawan A, Klemme WR, Polly DW Jr. Thoracic pedicle screws: comparison of start points and trajectories. Spine. 2008;33: 2675-2681.
3. Lehman RA Jr, Polly DW Jr, Kuklo TR, et al. Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine. 2003;28:2058-2065.
4. Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine. 2009;10:33-39.
5. Brown BS, McIff TE, Glattes RC, et al. The effect of starting point placement technique on thoracic transverse process strength: an ex vivo biomechanical study. Scoliosis. 2010;5:14.
6. Wagnac E, Michardiere D, Garo A, et al. Biomechanical analysis of pedicle screw placement: a feasibility study. Stud Health Technol Inform. 2010;158:167-171.
7. Zhang QH, Tan SH, Chou SM. Effects of bone materials on the screw pull-out strength in human spine. Med Eng Phys. 2006;28: 795-801.
8. Chen CS, Chen WJ, Cheng CK, et al. Failure analysis of broken pedicle screws on spinal instrumentation. Med Eng Phys. 2005; 27:487-496.
9. Modi HN, Suh SW, Fernandez H, et al. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J. 2008;17:1686-1696.
10. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg. 2000;82-A: 1458-1476.
11. Montgomery DC. Design and Analysis of Experiments. New York: Wiley; 1997.
12. Hirano T, Hasegawa K, Takahashi HE, et al. Structural characteristics of the pedicle and its role in screw stability. Spine. 1997;22: 2504-2510.
13. Silva MJ, Wang C, Keaveny TM, et al. Direct and computed tomography thickness measurements of the human, lumbar vertebral shell and endplate. Bone. 1994;15:409-414.
14. Liu CL, Chen HH, Cheng CK, et al. Biomechanical evaluation of a new anterior spinal implant. Clin Biomech. 1998;13(suppl 1):40-45.
15. Garo A, Arnoux PJ, Wagnac E, et al. Calibration of the mechanical properties in a finite element model of a lumbar vertebra under dynamic compression up to failure. Med Biol Eng Comput. 2011; 49:1371-1379.
16. El-Rich M, Arnoux PJ, Wagnac E, et al. Finite element investigation of the loading rate effect on the spinal load-sharing changes under impact conditions. J Biomech. 2009;42:1252-1262.
17. ASTM Standard F543-07. Standard Specification and Test Methods for Metallic Medical Bone Screws. ASTM International, West Conshohocken, PA; 2009.
18. Abshire BB, McLain RF, Valdevit A, et al. Characteristics of pullout failure in conical and cylindrical pedicle screws after full insertion and back-out. Spine J. 2001;1:408-414.
19. Inceoglu S, McLain RF, Cayli S, et al. Stress relaxation of bone significantly affects the pull-out behavior of pedicle screws. J Orthop Res. 2004;22:1243-1247.
20. Mehta H, Santos E, Ledonio C, et al. Biomechanical analysis of pedicle screw thread differential design in an osteoporotic cadaver model. Clin Biomech. 2012;27:234-240.
21. Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009;9:366-373.
22. Pfeiffer M, Gilbertson LG, Goel VK, et al. Effect of specimen fixation method on pullout tests of pedicle screws. Spine. 1996;21:1037-1044.
23. Cho W, Cho S, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg. 2010;92:1061-1065.
24. Wang X, Aubin CE, Labelle H, et al. Biomechanical analysis of corrective forces in spinal instrumentation for scoliosis treatment. Spine. 2012;37:1479-1487.
25. Hsu CC, Chao CK, Wang JL, et al. Increase of pullout strength of spinal pedicle screws with conical core: biomechanical tests and finite element analyses. J Orthop Res. 2005;23:788-794.
26. Kwok AWL, Finkelstein JA, Woodside T, et al. Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone. Spine. 1996;21:2429.
27. Inceoglu S, Ferrara L, McLain RF. Pedicle screw fixation strength: pullout versus insertional torque. Spine J. 2004;4:513-518.
28. Okuyama K, Abe E, Suzuki T, et al. Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion. Spine. 2000;25:858-864.
29. Inceoglu S, Kilinçer C, Tami A, et al. Cortex of the pedicle of the vertebral arch. Part I: deformation characteristics during screw insertion. J Neurosurg Spine. 2007;341-346.
30. Defino HLA. Study of the influence of the type of pilot hole preparation and tapping on pedicular screws fixation. Acta Ortop Bras. 2007;15:200-203.
31. Guillot J, ed. Assemblages par Elements Filetes. Modelisations et Calcul. Techniques de l'Ingenieur, Tome 1 B5560 a B5562, Paris, France; 1987.
32. Chatzistergos PE, Magnissalis EA, Kourkoulis SK. A parametric study of cylindrical pedicle screw design implications on the pullout performance using an experimentally validated finite-element model. Med Eng Phys. 2010;32:145-154.
33. Wirth AJ, Müller R, Harry van Lenthe G. The discrete nature of trabecular bone microarchitecture affects implant stability. J Biomech. 2012;1060-1067.
34. Schmidt H, Heuer F, Drumm J, et al. Application of a calibration method provides more realistic results for a finite element model of a lumbar spinal segment. Clin Biomech. 2007;22:377-384.
35. Defino HLA, Vendrame JR. Role of cortical and cancellous bone of the vertebral pedicle in implant fixation. Eur Spine J. 2001;10: 325-333.