Predicting Pedicle Screw Pullout and Fatigue Performance: Comparing Lateral Dual-Energy X-Ray Absorptiometry, Anterior to Posterior Dual-Energy X-Ray Absorptiometry, and Computed Tomography Hounsfield Units.
DEXA
Hounsfield
biomechanical
bone denisity
pedicle screw
pullout
Journal
International journal of spine surgery
ISSN: 2211-4599
Titre abrégé: Int J Spine Surg
Pays: Netherlands
ID NLM: 101579005
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
entrez:
22
2
2023
pubmed:
23
2
2023
medline:
23
2
2023
Statut:
ppublish
Résumé
As the prevalence and associated health care costs of osteoporosis continue to rise in our aging population, there is a growing need to continue to identify methods to predict spine construct integrity accurately and cost-effectively. Dual-energy x-ray absorptiometry (DEXA) in both anterior to posterior (AP) and lateral planes, as well as computed tomography (CT) Hounsfield units (HU), have all been investigated as potential preoperative predictive tools. The purpose of this study is to determine which of the 3 bone density analysis modalities has the highest potential for predicting pedicle screw biomechanics. Lumbar spine specimens (L2, L3, and L4) from 6 fresh frozen cadavers were used for testing. AP-DEXA, lateral-DEXA, and CT images were obtained. Biomechanical testing of pedicle screws in each vertebrae was then performed including pullout strength and fatigue testing. Statistical analysis was performed. Pullout strength was best predicted by CT HU, followed by AP-DEXA, then lateral-DEXA ( CT is the only modality with a statistically significant correlation to all biomechanical parameters measured (pullout strength, relative angular rotation, and relative translation). AP-DEXA also predicts the biomechanical measures of screw pullout and relative angular rotation and is superior to lateral-DEXA. CT may provide an incremental benefit in assessing fatigue strength, but this should be weighed against the disadvantages of cost and radiation. The results of this study can help to inform clinicians on different bone density analyses and their implications on pedicle screw failure.
Sections du résumé
BACKGROUND
BACKGROUND
As the prevalence and associated health care costs of osteoporosis continue to rise in our aging population, there is a growing need to continue to identify methods to predict spine construct integrity accurately and cost-effectively. Dual-energy x-ray absorptiometry (DEXA) in both anterior to posterior (AP) and lateral planes, as well as computed tomography (CT) Hounsfield units (HU), have all been investigated as potential preoperative predictive tools. The purpose of this study is to determine which of the 3 bone density analysis modalities has the highest potential for predicting pedicle screw biomechanics.
METHODS
METHODS
Lumbar spine specimens (L2, L3, and L4) from 6 fresh frozen cadavers were used for testing. AP-DEXA, lateral-DEXA, and CT images were obtained. Biomechanical testing of pedicle screws in each vertebrae was then performed including pullout strength and fatigue testing. Statistical analysis was performed.
RESULTS
RESULTS
Pullout strength was best predicted by CT HU, followed by AP-DEXA, then lateral-DEXA (
CONCLUSIONS
CONCLUSIONS
CT is the only modality with a statistically significant correlation to all biomechanical parameters measured (pullout strength, relative angular rotation, and relative translation). AP-DEXA also predicts the biomechanical measures of screw pullout and relative angular rotation and is superior to lateral-DEXA. CT may provide an incremental benefit in assessing fatigue strength, but this should be weighed against the disadvantages of cost and radiation.
CLINICAL RELEVANCE
CONCLUSIONS
The results of this study can help to inform clinicians on different bone density analyses and their implications on pedicle screw failure.
Identifiants
pubmed: 36805550
pii: 8356
doi: 10.14444/8356
pmc: PMC10025856
doi:
Types de publication
Journal Article
Langues
eng
Pagination
43-50Informations de copyright
This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
Déclaration de conflit d'intérêts
Declaration of Conflicting Interests: Wayne Cheng reports nonfinancial support from K2M during the conduct of the study. Otherwise, the authors report no conflicts of interest related to this article.
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