Biomechanical comparative study on stability of injectable pedicle screw with 1 different lateral holes augmented with different volumes of polymethylmethacrylate in osteoporotic lumbar vertebrae

Publication date: Available online 19 March 2018
Source:The Spine Journal
Author(s): Da Liu, Jun Sheng, Yang Luo, Chen Huang, Hong-Hua Wu, Jiang-Jun Zhou, Xiao-Jun Zhang, Wei Zheng
Background ContextPolymethylmethacrylate (PMMA) is widely used for pedicle screw augmentation in osteoporosis. Until now, there had been no studies of the relationship between screw stability and the distribution and volume of PMMA.PurposeTo analyze the relationship between screw stability and the distribution pattern and injected volume of PMMA.Study DesignBiomechanical comparison of injectable pedicle screws with different lateral holes augmented with different volumes of PMMA in cadaveric osteoporotic lumbar vertebrae.MethodsForty-eight osteoporotic lumbar vertebrae were randomly divided into groups A, B, C with different pedicle screws (16 vertebrae in each group), and then each group was randomly divided into subgroups 0, 1, 2, 3 with different volumes of PMMA (four vertebra with eight pedicles in each subgroup). A pilot hole was prepared in advance using the same method in all samples. Type A and type B pedicle screws were directly inserted into vertebrae in groups A and B, respectively, and then different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL) were injected through the screws and into vertebrae in subgroups 0, 1, 2, and 3. The pilot holes were filled with different volumes of PMMA (0, 1.0, 1.5, and 2.0 mL), and then the screws were inserted in groups C0, C1, C2 and C3. Screw position and distribution of PMMA were evaluated radiographically, and axial pull-out tests were performed to measure maximum axial pullout strength (Fmax).ResultsPMMA surrounded the anterior one-third of screws in the vertebral body in groups A1, A2, and A3; the middle one-third of screws in the junction area of the vertebral body and the pedicle in groups B1, B2, and B3; and the full length of screws evenly in both the vertebral body and the pedicle in groups C1, C2, and C3. There was no malpositioning of screws or leakage of PMMA in any sample. Two-way analysis of variance revealed that two factors—distribution and volume of PMMA—significantly influenced Fmax (p < .05) but that they were not significantly correlated (p = .088). Fmax in groups using augmentation with PMMA values were significantly improved compared with those in groups without PMMA (p < .05).ConclusionsPMMA can significantly enhance the stability of different injectable pedicle screws in osteoporotic lumbar vertebrae, and screw stability is significantly correlated with the distribution pattern and injected volume of PMMA. The closer the PMMA to the pedicle and the greater the quantity of injected PMMA, the greater pedicle screw stability is. Injection of 2.0 mL of PMMA through screws with four lateral 180° holes or of 1.0 mL of PMMA through screws with six lateral 180° holes increases the stability of pedicle screws.



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