Pullout performance comparison of pedicle screws based on cement application and design parameters.

Pedicle screws are the main fixation devices for certain surgeries. Pedicle screw loosening is a common problem especially for osteoporotic incidents. Cannulated screws with cement augmentation are widely used for that kind of cases. Dual lead dual cored pedicle screw has already given promising pullout values without augmentation. This study concentrates on the usage of dual lead dual core with cement augmentation as an alternative to cannulated and standard pedicle screws with cement augmentation. Five groups (dual lead dual core, normal pedicle screw and cannulated pedicle screw with augmentation, normal pedicle screw, dual lead dual cored pedicle screw) were designed for this study. Healthy bovine vertebrae and synthetic polyurethane foams (grade 20) were used as embedding test medium. Test samples were prepared in accordance with surgical guidelines and ASTM F543 standard testing protocols. Pullout tests were conducted with Instron 3300 testing frame. Load versus displacement values were recorded and maximum pullout loads were stated. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation exhibited the highest pullout values, while dual lead dual cored pedicle screw demonstrated similar pullout strength as cannulated pedicle screw and normal pedicle screw with poly-methyl methacrylate augmentation. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation can be used for osteoporotic and/or severe osteoporotic patients according to its promising results on animal cadaver and synthetic foams.

Postfusion pullout strength comparison of a novel pedicle screw with classical pedicle screws on synthetic foams.

Pullout is a very common failure mode on the use of pedicle screws. Numerous studies were completed to increase the pullout strength of pedicle screws especially for osteoporotic bones. In this study, a previously designed pedicle screw type was tested before and after fusion condition. Synthetic polyurethane foams were used in all tests. Three different grades of foams were used in tests to simulate severely osteoporotic, osteoporotic, and healthy bones. Test blocks were produced and characterized in our clinical biomechanics laboratory. Foaming of polyurethane was accepted as fusion process (bone in growth). Pedicle screw including radial holes (new design) was tested both before and after the fusion. It also exhibited remarkably higher pullout strength after fusion than before fusion and most of other alternatives stated in the literature. In total, 70% higher pullout strength was achieved with new design after fusion. On the other hand, new design did not dominate other alternatives when comparison was carried out on severely osteoporotic and healthy bones. To the knowledge of the authors, this is the first study investigating the postfusion properties on synthetic foams.