Complex biomechanical properties of non-augmented and augmented pedicle screws in human vertebrae with reduced bone density.
Aged
Aged, 80 and over
Biomechanical Phenomena
Bone Cements
Bone Density
Bone-Anchored Prosthesis
Bone-Implant Interface
Humans
Lumbar Vertebrae
/ physiology
Materials Testing
/ methods
Middle Aged
Osteoporosis
/ surgery
Pedicle Screws
Polymethyl Methacrylate
Prosthesis Failure
Spinal Fusion
/ methods
Weight-Bearing
Biomechanics
Cyclic loading
Lumbar vertebrae
Pedicle screws
Physiologically related setup
Reduced BMD
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
06 Mar 2020
06 Mar 2020
Historique:
received:
27
11
2019
accepted:
24
02
2020
entrez:
8
3
2020
pubmed:
8
3
2020
medline:
22
12
2020
Statut:
epublish
Résumé
In osteoporotic bone, the quality of the bone-to-implant interface is decreased, which may lead to early implant failure. Screw anchorage can be improved by augmentation. This effect is mainly investigated with a pull-out test. To our knowledge, the effect of cement augmentation in an in vivo physiological setup focusing on screw movement has not been investigated to date. The aim of this work was to investigate and compare augmented and native screw behavior in a physiologically related setup. Twelve fresh-frozen human lumbar vertebrae were divided into two groups. Each vertebra was bilaterally instrumented with either non-augmented or augmented pedicle screw systems and loaded in a recently developed test setup that provided cyclic conditions comparable to a physiological gait. The cyclic loading should test the primary implant stability, comparable to the postoperative period of two months in a worst-case scenario in the absence of osseous remodeling. Screws were tracked optically, and screw movement and failure patterns were observed. Mutual influence between the left and right sides resulted in a successive, rather than simultaneous, failure. Augmentation of the screws in vertebrae with poor bone quality reduced screw subsidence and thus improved the rigidity of the screw-to-implant interface by up to six-fold. The non-augmented condition was significantly related to early screw failure. Pedicle screw system failure involves a complex bilateral-coupled mechanism. The cyclic loading based on physiological conditions during walking has allowed the postoperative conditions and clinical failure mechanisms to be simulated in vitro and clarified. Future implant systems should be investigated with a physiologically related setup.
Sections du résumé
BACKGROUND
BACKGROUND
In osteoporotic bone, the quality of the bone-to-implant interface is decreased, which may lead to early implant failure. Screw anchorage can be improved by augmentation. This effect is mainly investigated with a pull-out test. To our knowledge, the effect of cement augmentation in an in vivo physiological setup focusing on screw movement has not been investigated to date. The aim of this work was to investigate and compare augmented and native screw behavior in a physiologically related setup.
METHODS
METHODS
Twelve fresh-frozen human lumbar vertebrae were divided into two groups. Each vertebra was bilaterally instrumented with either non-augmented or augmented pedicle screw systems and loaded in a recently developed test setup that provided cyclic conditions comparable to a physiological gait. The cyclic loading should test the primary implant stability, comparable to the postoperative period of two months in a worst-case scenario in the absence of osseous remodeling. Screws were tracked optically, and screw movement and failure patterns were observed.
RESULTS
RESULTS
Mutual influence between the left and right sides resulted in a successive, rather than simultaneous, failure. Augmentation of the screws in vertebrae with poor bone quality reduced screw subsidence and thus improved the rigidity of the screw-to-implant interface by up to six-fold. The non-augmented condition was significantly related to early screw failure.
CONCLUSIONS
CONCLUSIONS
Pedicle screw system failure involves a complex bilateral-coupled mechanism. The cyclic loading based on physiological conditions during walking has allowed the postoperative conditions and clinical failure mechanisms to be simulated in vitro and clarified. Future implant systems should be investigated with a physiologically related setup.
Identifiants
pubmed: 32143605
doi: 10.1186/s12891-020-3158-z
pii: 10.1186/s12891-020-3158-z
pmc: PMC7060638
doi:
Substances chimiques
Bone Cements
0
Polymethyl Methacrylate
9011-14-7
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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