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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2018 | Research article

Effect of pedicle screw augmentation with a self-curing elastomeric material under cranio-caudal cyclic loading—a cadaveric biomechanical study

Authors: Werner Schmoelz, Alexander Keiler, Marko Konschake, Richard A Lindtner, Alessandro Gasbarrini

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Pedicle screws can be augmented with polymethylmethacrylate (PMMA) cement through cannulated and fenestrated pedicle screws to improve screw anchorage. To overcome the drawbacks of PMMA, a modified augmentation technique applying a self-curing elastomeric material into a balloon-created cavity prior to screw insertion was developed and evaluated. The aim of the study was to compare the effect of the established and novel augmentation technique on pedicle screw anchorage in a biomechanical in vitro experiment.

Methods

In ten lumbar vertebral bodies, the right pedicles were instrumented with monoaxial cannulated and fenestrated pedicle screws and augmented in situ with 2 ml PMMA. The left pedicles were instrumented with monoaxial cannulated pedicle screws. Prior to left screw insertion, a balloon cavity was created and filled with 3 ml of self-curing elastomer (silicone). Each screw was subjected to a cranio-caudal cyclic load starting from − 50 to 50 N while the upper load was increased by 5 N every 100 load cycles until loosening or 11,000 cycles (600 N). After cyclic loading, a pullout test of the screws was conducted.

Results

The mean cycles to screw loosening were 9824 ± 1982 and 7401 ± 1644 for the elastomer and PMMA group, respectively (P = 0.012). The post-cycling pullout test of the loosened screws showed differences in the failure mode and failure load, with predominantly pedicle/vertebrae fractures in the PMMA group (1188.6 N ± 288.1) and screw pullout through the pedicle (671.3 N ± 332.1) in the elastomer group.

Conclusion

The modified pedicle screw augmentation technique involving a balloon cavity creation and a self-curing elastomeric silicone resulted in a significantly improved pedicle screw anchorage under cyclic cranio-caudal loading when compared to conventional in situ PMMA augmentation.

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Title: Effect of pedicle screw augmentation with a self-curing elastomeric material under cranio-caudal cyclic loading—a cadaveric biomechanical study
Authors: Werner Schmoelz
Alexander Keiler
Marko Konschake
Richard A Lindtner
Alessandro Gasbarrini
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0958-z

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Effect of pedicle screw augmentation with a self-curing elastomeric material under cranio-caudal cyclic loading—a cadaveric biomechanical study

Abstract

Background

Methods

Results

Conclusion

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Abstract

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