Characterization of vertebral strength using digital radiographic analysis of bone structure.

Bone mineral densitometry (BMD) is useful in predicting fracture risk, but, unfortunately, there is a significant degree of overlap in BMD measurements of patients who have a high risk of fracture and patients with a low risk of fracture. In this study, a method of characterizing trabecular bone structure in digitized radiographs of vertebrae is proposed and assessed. A significant correlation between bone "structure" and the compressive strength of vertebral bodies was found. The utility of the parameter for distinguishing between "weak" and "strong" bone samples was assessed using receiver operating characteristic (ROC) analysis. Using this analysis, the structural parameter produced an area under the ROC of 0.88 +/- 0.05, while a bone density measure produced an area of 0.79 +/- 0.07. The results suggest that the addition of a measure of bone structure to the conventional measures of bone density may prove useful in predicting the quality of bone when considering surgical or medical intervention for osteoporotic conditions.

Biomechanical testing of a new design for Schanz pedicle screws.

Standard 5-mm AO Schanz pedicle screws were biomechanically compared with a new design, featuring 6-mm threads with a 5-mm core diameter continuous with the shaft. One each of the two screw designs was surgically inserted into the matching pedicles of 32 cadaveric vertebrae. The pull-out strengths of the screws were then determined by recording the peak force values during extraction under servohydraulic displacement control. The screws were also tested in three-point bending, varying the inner load point with respect to the shaft thread junction, within a clinically anticipated range. The mean pull-out strength for the 6-mm screw was 597 N, which was significantly greater than the mean strength of 405 N for the 5 mm screw (p = 0.002). The 6-mm screw was also stronger in three-point bending, and failed at the point of inner load application, with no evidence of a stress-raising effect at the shaft/thread junction. In contrast, the 5-mm screw withstood lower loads, and failed at the shaft/thread junction, regardless of the point of loading. Pedicle screw breakage and pull-out are the recognized modes of failure of spinal implants, which are dependent on pedicle screw fixation. The results suggest distinct biomechanical advantages for the 6-mm screw, which should be used whenever clinically feasible.