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Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing
Purpose For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relev...
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| Published in: | European spine journal 2014-10, Vol.23 (10), p.2196-2202 |
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| Main Authors: | , , , , , |
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| cites | cdi_FETCH-LOGICAL-c475t-a0e2d85e9d4783bdaa9a4f81fa2a7b64dc17041d7c5a21ce5603ace79a854f0c3 |
| container_end_page | 2202 |
| container_issue | 10 |
| container_start_page | 2196 |
| container_title | European spine journal |
| container_volume | 23 |
| creator | Kueny, Rebecca A. Kolb, Jan P. Lehmann, Wolfgang Püschel, Klaus Morlock, Michael M. Huber, Gerd |
| description | Purpose
For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing.
Methods
Thirty-nine osteoporotic, human lumbar vertebrae were instrumented with pedicle screws according to four treatment groups: (1) screw only (control), (2) prefilled augmentation, (3) screw injected augmentation, and (4) unaugmented screws with an increased diameter. Toggle testing was first performed on one pedicle, using a cranial-caudal sinusoidal, cyclic (1.0 Hz) fatigue loading applied at the screw head. The initial compressive forces ranged from 25 to 75 N. Peak force increased stepwise by 25 N every 250 cycles until a 5.4-mm screw head displacement. The contralateral screw then underwent pure axial pullout (5 mm/min).
Results
When compared to the control group, screw injected augmentation increased fatigue force (27 %,
p
= 0.045) while prefilled augmentation reduced fatigue force (−7 %,
p
= 0.73). Both augmentation techniques increased pullout force compared to the control (
p
s |
| doi_str_mv | 10.1007/s00586-014-3476-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1611635938</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1611635938</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-a0e2d85e9d4783bdaa9a4f81fa2a7b64dc17041d7c5a21ce5603ace79a854f0c3</originalsourceid><addsrcrecordid>eNqFkctu1TAQhi1ERQ-FB2CDLLFhEzpOfEnYoYpLpUrdwNryccanrhI72A6FR-FtcUmLEBLqahbzff9o9BPygsEbBqBOM4DoZQOMNx1XslGPyI7xrm1g6NrHZAcDh0YqNhyTpzlfAzAxgHxCjlsBfavEsCM_z4ObVgwWaXS0XCHNNuENNethxlBM8THQgvYq-K8rUhNGaujozYwFE_WhwiZXN9AFR2-ne9_575vrw-_UmAvGJaZYvKV58QHf0mWdprgW-g1TXjN1VTjUGwVz8eHwjBw5M2V8fjdPyJcP7z-ffWouLj-en727aCxXojQGsB17gcPIVd_tR2MGw13PnGmN2ks-WqaAs1FZYVpmUUjojEU1mF5wB7Y7Ia-33CXF-mIuevbZ4jSZgHHNmknGZCeGrn8YFbLCrI6KvvoHvY5rCvWRjQLJRFsptlE2xZwTOr0kP5v0QzPQtxXrrWJdK9a3FWtVnZd3yet-xvGPcd9pBdoNyHUVDpj-Ov3f1F9WLbRC</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1566106152</pqid></control><display><type>article</type><title>Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing</title><source>Springer Link</source><source>PubMed Central</source><creator>Kueny, Rebecca A. ; Kolb, Jan P. ; Lehmann, Wolfgang ; Püschel, Klaus ; Morlock, Michael M. ; Huber, Gerd</creator><creatorcontrib>Kueny, Rebecca A. ; Kolb, Jan P. ; Lehmann, Wolfgang ; Püschel, Klaus ; Morlock, Michael M. ; Huber, Gerd</creatorcontrib><description>Purpose
For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing.
Methods
Thirty-nine osteoporotic, human lumbar vertebrae were instrumented with pedicle screws according to four treatment groups: (1) screw only (control), (2) prefilled augmentation, (3) screw injected augmentation, and (4) unaugmented screws with an increased diameter. Toggle testing was first performed on one pedicle, using a cranial-caudal sinusoidal, cyclic (1.0 Hz) fatigue loading applied at the screw head. The initial compressive forces ranged from 25 to 75 N. Peak force increased stepwise by 25 N every 250 cycles until a 5.4-mm screw head displacement. The contralateral screw then underwent pure axial pullout (5 mm/min).
Results
When compared to the control group, screw injected augmentation increased fatigue force (27 %,
p
= 0.045) while prefilled augmentation reduced fatigue force (−7 %,
p
= 0.73). Both augmentation techniques increased pullout force compared to the control (
p
s < 0.04). Increasing the screw diameter by 1 mm increased pullout force (24 %,
p
= 0.19), fatigue force (5 %,
p
= 0.73), and induced the least stiffness loss (−29 %) from control.
Conclusions
For the osteoporotic spine, screw injected augmentation showed the best biomechanical stability. Although pullout testing was more sensitive, the differences observed were not reflected in the more physiological fatigue testing, thus casting further doubt on the clinical relevance of pullout testing.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-014-3476-7</identifier><identifier>PMID: 25082759</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Biomechanical Phenomena ; Bone Cements ; Equipment Failure Analysis ; Female ; Humans ; Lumbar Vertebrae - physiology ; Lumbar Vertebrae - surgery ; Male ; Materials Testing ; Medicine ; Medicine & Public Health ; Neurosurgery ; Original Article ; Osteoporosis - surgery ; Pedicle Screws - adverse effects ; Spinal Fusion - adverse effects ; Spinal Fusion - instrumentation ; Spinal Fusion - methods ; Surgical Orthopedics</subject><ispartof>European spine journal, 2014-10, Vol.23 (10), p.2196-2202</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-a0e2d85e9d4783bdaa9a4f81fa2a7b64dc17041d7c5a21ce5603ace79a854f0c3</citedby><cites>FETCH-LOGICAL-c475t-a0e2d85e9d4783bdaa9a4f81fa2a7b64dc17041d7c5a21ce5603ace79a854f0c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25082759$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kueny, Rebecca A.</creatorcontrib><creatorcontrib>Kolb, Jan P.</creatorcontrib><creatorcontrib>Lehmann, Wolfgang</creatorcontrib><creatorcontrib>Püschel, Klaus</creatorcontrib><creatorcontrib>Morlock, Michael M.</creatorcontrib><creatorcontrib>Huber, Gerd</creatorcontrib><title>Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing.
Methods
Thirty-nine osteoporotic, human lumbar vertebrae were instrumented with pedicle screws according to four treatment groups: (1) screw only (control), (2) prefilled augmentation, (3) screw injected augmentation, and (4) unaugmented screws with an increased diameter. Toggle testing was first performed on one pedicle, using a cranial-caudal sinusoidal, cyclic (1.0 Hz) fatigue loading applied at the screw head. The initial compressive forces ranged from 25 to 75 N. Peak force increased stepwise by 25 N every 250 cycles until a 5.4-mm screw head displacement. The contralateral screw then underwent pure axial pullout (5 mm/min).
Results
When compared to the control group, screw injected augmentation increased fatigue force (27 %,
p
= 0.045) while prefilled augmentation reduced fatigue force (−7 %,
p
= 0.73). Both augmentation techniques increased pullout force compared to the control (
p
s < 0.04). Increasing the screw diameter by 1 mm increased pullout force (24 %,
p
= 0.19), fatigue force (5 %,
p
= 0.73), and induced the least stiffness loss (−29 %) from control.
Conclusions
For the osteoporotic spine, screw injected augmentation showed the best biomechanical stability. Although pullout testing was more sensitive, the differences observed were not reflected in the more physiological fatigue testing, thus casting further doubt on the clinical relevance of pullout testing.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomechanical Phenomena</subject><subject>Bone Cements</subject><subject>Equipment Failure Analysis</subject><subject>Female</subject><subject>Humans</subject><subject>Lumbar Vertebrae - physiology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Materials Testing</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Osteoporosis - surgery</subject><subject>Pedicle Screws - adverse effects</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - instrumentation</subject><subject>Spinal Fusion - methods</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFkctu1TAQhi1ERQ-FB2CDLLFhEzpOfEnYoYpLpUrdwNryccanrhI72A6FR-FtcUmLEBLqahbzff9o9BPygsEbBqBOM4DoZQOMNx1XslGPyI7xrm1g6NrHZAcDh0YqNhyTpzlfAzAxgHxCjlsBfavEsCM_z4ObVgwWaXS0XCHNNuENNethxlBM8THQgvYq-K8rUhNGaujozYwFE_WhwiZXN9AFR2-ne9_575vrw-_UmAvGJaZYvKV58QHf0mWdprgW-g1TXjN1VTjUGwVz8eHwjBw5M2V8fjdPyJcP7z-ffWouLj-en727aCxXojQGsB17gcPIVd_tR2MGw13PnGmN2ks-WqaAs1FZYVpmUUjojEU1mF5wB7Y7Ia-33CXF-mIuevbZ4jSZgHHNmknGZCeGrn8YFbLCrI6KvvoHvY5rCvWRjQLJRFsptlE2xZwTOr0kP5v0QzPQtxXrrWJdK9a3FWtVnZd3yet-xvGPcd9pBdoNyHUVDpj-Ov3f1F9WLbRC</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Kueny, Rebecca A.</creator><creator>Kolb, Jan P.</creator><creator>Lehmann, Wolfgang</creator><creator>Püschel, Klaus</creator><creator>Morlock, Michael M.</creator><creator>Huber, Gerd</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing</title><author>Kueny, Rebecca A. ; Kolb, Jan P. ; Lehmann, Wolfgang ; Püschel, Klaus ; Morlock, Michael M. ; Huber, Gerd</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-a0e2d85e9d4783bdaa9a4f81fa2a7b64dc17041d7c5a21ce5603ace79a854f0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomechanical Phenomena</topic><topic>Bone Cements</topic><topic>Equipment Failure Analysis</topic><topic>Female</topic><topic>Humans</topic><topic>Lumbar Vertebrae - physiology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Materials Testing</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Osteoporosis - surgery</topic><topic>Pedicle Screws - adverse effects</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - instrumentation</topic><topic>Spinal Fusion - methods</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kueny, Rebecca A.</creatorcontrib><creatorcontrib>Kolb, Jan P.</creatorcontrib><creatorcontrib>Lehmann, Wolfgang</creatorcontrib><creatorcontrib>Püschel, Klaus</creatorcontrib><creatorcontrib>Morlock, Michael M.</creatorcontrib><creatorcontrib>Huber, Gerd</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kueny, Rebecca A.</au><au>Kolb, Jan P.</au><au>Lehmann, Wolfgang</au><au>Püschel, Klaus</au><au>Morlock, Michael M.</au><au>Huber, Gerd</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>23</volume><issue>10</issue><spage>2196</spage><epage>2202</epage><pages>2196-2202</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing.
Methods
Thirty-nine osteoporotic, human lumbar vertebrae were instrumented with pedicle screws according to four treatment groups: (1) screw only (control), (2) prefilled augmentation, (3) screw injected augmentation, and (4) unaugmented screws with an increased diameter. Toggle testing was first performed on one pedicle, using a cranial-caudal sinusoidal, cyclic (1.0 Hz) fatigue loading applied at the screw head. The initial compressive forces ranged from 25 to 75 N. Peak force increased stepwise by 25 N every 250 cycles until a 5.4-mm screw head displacement. The contralateral screw then underwent pure axial pullout (5 mm/min).
Results
When compared to the control group, screw injected augmentation increased fatigue force (27 %,
p
= 0.045) while prefilled augmentation reduced fatigue force (−7 %,
p
= 0.73). Both augmentation techniques increased pullout force compared to the control (
p
s < 0.04). Increasing the screw diameter by 1 mm increased pullout force (24 %,
p
= 0.19), fatigue force (5 %,
p
= 0.73), and induced the least stiffness loss (−29 %) from control.
Conclusions
For the osteoporotic spine, screw injected augmentation showed the best biomechanical stability. Although pullout testing was more sensitive, the differences observed were not reflected in the more physiological fatigue testing, thus casting further doubt on the clinical relevance of pullout testing.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25082759</pmid><doi>10.1007/s00586-014-3476-7</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2014-10, Vol.23 (10), p.2196-2202 |
| issn | 0940-6719 1432-0932 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1611635938 |
| source | Springer Link; PubMed Central |
| subjects | Aged Aged, 80 and over Biomechanical Phenomena Bone Cements Equipment Failure Analysis Female Humans Lumbar Vertebrae - physiology Lumbar Vertebrae - surgery Male Materials Testing Medicine Medicine & Public Health Neurosurgery Original Article Osteoporosis - surgery Pedicle Screws - adverse effects Spinal Fusion - adverse effects Spinal Fusion - instrumentation Spinal Fusion - methods Surgical Orthopedics |
| title | Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing |
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