Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers
Objective: This study aimed (1) to simulate pedicle screw pullout after intraoperative external wall perforation and (2) to assess restoration strength with different thread designs in the pedicle screw instrumentation for osteoporotic thoracic vertebrae. Methods: Twenty fresh-frozen human cadave...
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| Format: | Article |
| Language: | English |
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AVES
2024-01-01
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| Series: | Acta Orthopaedica et Traumatologica Turcica |
| Online Access: | https://www.aott.org.tr/en/intraoperative-lateral-wall-breach-simulation-in-the-cadaveric-spine-and-the-impact-of-thread-designs-of-screws-on-pullout-strength-in-the-osteoporotic-thoracic-vertebrae-a-biomechanical-study-in-human-cadavers-137377 |
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| author | Ozcan Kaya Okan Ozkunt Mustafa Sungur Mehmet Semih Cakir Murat Baydogan Kerim Sariyilmaz |
| author_facet | Ozcan Kaya Okan Ozkunt Mustafa Sungur Mehmet Semih Cakir Murat Baydogan Kerim Sariyilmaz |
| author_sort | Ozcan Kaya |
| collection | DOAJ |
| description | Objective: This study aimed (1) to simulate pedicle screw pullout after intraoperative external wall perforation and (2) to assess restoration strength with different thread designs in the pedicle screw instrumentation for osteoporotic thoracic vertebrae.
Methods: Twenty fresh-frozen human cadaveric thoracic vertebra bodies were prepared and divided into 4 groups: group 1, 5.5 mm × 45 mm polyaxial single thread pedicle screws (PASTS); group 2, after wall injury 5.5 mm × 45 mm PASTS; group 3, 6.5 mm × 45 mm PASTS after wall injury; and group 4: 6.5 mm × 45 mm polyaxial mixed-threaded screws after wall injury. While group 1 was the control group, groups 2, 3, and 4 were used as study groups after the lateral wall breach. All prepared screw units were placed on a universal pullout measurement testing device.
Results: The mean bone mineral density for 20 thoracic vertebrae was 0.57 ± 0.12 g/cm2 (range 0.53-0.6 g/cm2 ). The mean pullout strength was 474.90 Newtons (N) for group 1, 412.85 N for group 2, 475.4 N for group 3, and 630.74N for group 4. The lateral wall breach caused a 14.1 % decrease in average pullout strength compared with the initial screw pullout. Mixed (double)-threaded screws increased pullout strength compared to 6.5 mm screws (P=.036)
Conclusion: Using a 1 mm thicker polyaxial pedicle screw or mixed (double)-threaded pedicle screw seems to increase pullout strength; however, this was statistically significant only for group 4. In the thoracic spine, the redirection possibility of the pedicle screw is limited, and augmentation with cement will not be appropriate due to the risk of wall injury-related leakage. Therefore, care should be taken to avoid violating the lateral cortex by using appropriate pedicle entry points and trajectories. |
| format | Article |
| id | doaj-art-ff2c87da154847b282f7b687c5523c7f |
| institution | Kabale University |
| issn | 1017-995X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | AVES |
| record_format | Article |
| series | Acta Orthopaedica et Traumatologica Turcica |
| spelling | doaj-art-ff2c87da154847b282f7b687c5523c7f2024-11-20T08:50:59ZengAVESActa Orthopaedica et Traumatologica Turcica1017-995X2024-01-01581576110.5152/j.aott.2024.22067Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadaversOzcan Kaya0Okan Ozkunt1Mustafa Sungur2Mehmet Semih Cakir3Murat Baydogan4Kerim Sariyilmaz5Department of Orthopedics and Traumatology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TurkeyDepartment of Orthopedics and Traumatology, Medicana Istanbul Bahçelievler Hospital, Istanbul, TurkeyDepartment of Orthopedics and Traumatology, Acıbadem MAA University, School of Medicine, Istanbul, TurkeyDepartment of Interventional Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TurkeyIstanbul Technical University, Istanbul, TurkeyDepartment of Orthopedics and Traumatology, Acıbadem MAA University, School of Medicine, Istanbul, TurkeyObjective: This study aimed (1) to simulate pedicle screw pullout after intraoperative external wall perforation and (2) to assess restoration strength with different thread designs in the pedicle screw instrumentation for osteoporotic thoracic vertebrae. Methods: Twenty fresh-frozen human cadaveric thoracic vertebra bodies were prepared and divided into 4 groups: group 1, 5.5 mm × 45 mm polyaxial single thread pedicle screws (PASTS); group 2, after wall injury 5.5 mm × 45 mm PASTS; group 3, 6.5 mm × 45 mm PASTS after wall injury; and group 4: 6.5 mm × 45 mm polyaxial mixed-threaded screws after wall injury. While group 1 was the control group, groups 2, 3, and 4 were used as study groups after the lateral wall breach. All prepared screw units were placed on a universal pullout measurement testing device. Results: The mean bone mineral density for 20 thoracic vertebrae was 0.57 ± 0.12 g/cm2 (range 0.53-0.6 g/cm2 ). The mean pullout strength was 474.90 Newtons (N) for group 1, 412.85 N for group 2, 475.4 N for group 3, and 630.74N for group 4. The lateral wall breach caused a 14.1 % decrease in average pullout strength compared with the initial screw pullout. Mixed (double)-threaded screws increased pullout strength compared to 6.5 mm screws (P=.036) Conclusion: Using a 1 mm thicker polyaxial pedicle screw or mixed (double)-threaded pedicle screw seems to increase pullout strength; however, this was statistically significant only for group 4. In the thoracic spine, the redirection possibility of the pedicle screw is limited, and augmentation with cement will not be appropriate due to the risk of wall injury-related leakage. Therefore, care should be taken to avoid violating the lateral cortex by using appropriate pedicle entry points and trajectories.https://www.aott.org.tr/en/intraoperative-lateral-wall-breach-simulation-in-the-cadaveric-spine-and-the-impact-of-thread-designs-of-screws-on-pullout-strength-in-the-osteoporotic-thoracic-vertebrae-a-biomechanical-study-in-human-cadavers-137377 |
| spellingShingle | Ozcan Kaya Okan Ozkunt Mustafa Sungur Mehmet Semih Cakir Murat Baydogan Kerim Sariyilmaz Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers Acta Orthopaedica et Traumatologica Turcica |
| title | Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers |
| title_full | Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers |
| title_fullStr | Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers |
| title_full_unstemmed | Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers |
| title_short | Intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae: A biomechanical study in human cadavers |
| title_sort | intraoperative lateral wall breach simulation in the cadaveric spine and the impact of thread designs of screws on pullout strength in the osteoporotic thoracic vertebrae a biomechanical study in human cadavers |
| url | https://www.aott.org.tr/en/intraoperative-lateral-wall-breach-simulation-in-the-cadaveric-spine-and-the-impact-of-thread-designs-of-screws-on-pullout-strength-in-the-osteoporotic-thoracic-vertebrae-a-biomechanical-study-in-human-cadavers-137377 |
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