Effect of pilot hole on biomechanical and in vivo pedicle screw–bone interface

Silva, Patrícia; Rosa, Rodrigo César; Shimano, Antonio Carlos; Defino, Helton Luíz Aparecido

doi:10.1007/s00586-013-2810-9

Cited by 23 publications

(28 citation statements)

References 41 publications

(60 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple studies have been conducted to examine stability characteristics of pedicle screw systems using polyurethane foams, 4,5,13 animal spines, 16,23 and human cadaveric spines. Although polyurethane foams have mechanical properties simulating human cancellous bone and offer the advantages of homogeneity and reproducibility, it is difficult to replicate the complex and 3D structure of the pediclevertebral body.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Matsukawa

Yato

Imabayashi

et al. 2015

SPI

107

View full text Add to dashboard Cite

OBJECT Cortical bone trajectory (CBT) maximizes thread contact with the cortical bone surface and provides increased fixation strength. Even though the superior stability of axial screw fixation has been demonstrated, little is known about the biomechanical stiffness against multidirectional loading or its characteristics within a unit construct. The purpose of the present study was to quantitatively evaluate the anchorage performance of CBT by the finite element (FE) method. METHODS Thirty FE models of L-4 vertebrae from human spines (mean age [± SD] 60.9 ± 18.7 years, 14 men and 16 women) were computationally created and pedicle screws were placed using the traditional trajectory (TT) and CBT. The TT screw was 6.5 mm in diameter and 40 mm in length, and the CBT screw was 5.5 mm in diameter and 35 mm in length. To make a valid comparison, the same shape of screw was inserted into the same pedicle in each subject. First, the fixation strength of a single pedicle screw was compared by axial pullout and multidirectional loading tests. Next, vertebral fixation strength within a construct was examined by simulating the motions of flexion, extension, lateral bending, and axial rotation. RESULTS CBT demonstrated a 26.4% greater mean pullout strength (POS; p = 0.003) than TT, and also showed a mean 27.8% stronger stiffness (p < 0.05) during cephalocaudal loading and 140.2% stronger stiffness (p < 0.001) during mediolateral loading. The CBT construct had superior resistance to flexion and extension loading and inferior resistance to lateral bending and axial rotation. The vertebral fixation strength of the construct was significantly correlated with bone mineral density of the femoral neck and the POS of a single screw. CONCLUSIONS CBT demonstrated superior fixation strength for each individual screw and sufficient stiffness in flexion and extension within a construct. The TT construct was superior to the CBT construct during lateral bending and axial rotation.

show abstract

Section: Discussionmentioning

confidence: 99%

“…19 These factors play important roles in pedicle screw fixation and may be topics of further consideration. 5,23 A second limitation is that we used FE models of single segments of the vertebra. The multiple segment and screw-rod construct model provides a better representation of the actual situation.…”

mentioning

confidence: 99%

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Matsukawa

Yato

Imabayashi

et al. 2015

SPI

107

View full text Add to dashboard Cite

show abstract

“…16 Should a pilot hole be used, and should it be smaller than the internal screw diameter, there is a possibility of an increase in radial displacement and blockage (impaction) of cancellous bone while the screw (especially the core) is driven into the bone itself. This, in turn, involves more interaction between the screw and the adjacent bone and more bone makes its way into the thread.…”

Section: Discussionmentioning

confidence: 99%

“…13,18,19 In the present study, the comparative analysis of the pullout strength of self-drilling and self-tapping screws revealed higher strength in the former, which is due to the higher degree of interaction between the bone and thread (or, in the present study, the greater quantity of polyurethane foam in the thread). 16 In clinical applications, self-drilling screws should be used carefully, especially in 1.5 mm diameter systems, due to the possibility of screw head damage.…”

Section: Discussionmentioning

confidence: 99%

Pullout force comparison of selected screws for rigid fixation in maxillofacial surgery

Kozakiewicz¹,

Sołtysiak²

2017

Dent. Med. Probl.

View full text Add to dashboard Cite

show abstract

“…One strategy for enhancing screw fixation is modification of the screw path before screw insertion, including the pilot and tapping holes. Biomechanical studies demonstrated that a pilot hole size smaller than the core diameter of the screw and an under-size-tapping smaller than the outer diameter of the planned screw improve the fixation strength of pedicle screws 3,4) . Another strategy influencing screw fixation is alteration of the transpedicular screw path from the conventional screw path.…”

Section: Introductionmentioning

confidence: 99%

Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints

Matsukawa

Yato

2017

Spine Surg Relat Res

View full text Add to dashboard Cite

Abstract:Over the past few decades, many attempts to enhance the integrity of the bone-screw interface have been made to prevent pedicle screw failure and to achieve a better clinical outcome when treating a variety of spinal disorders. Cortical bone trajectory (CBT) has been developed as an alternative to the traditional lumbar pedicle screw trajectory. Contrary to the traditional trajectory, which follows the anatomical axis of the pedicle from a lateral starting point, CBT starts at the lateral part of the pars interarticularis and follows a mediolateral and caudocranial screw path through the pedicle. By markedly altering the screw path, CBT has the advantage of achieving a higher level of thread contact with the cortical bone from the dorsal entry point to the vertebral body. Biomechanical studies demonstrated the superior anchoring ability of CBT over the traditional trajectory, even with a shorter and smaller CBT screw. Furthermore, screw insertion from a more medial and caudal starting point requires less exposure and minimizes the procedure-related morbidity, such as reducing damage to the paraspinal muscles, avoiding iatrogenic injury to the cranial facet joint, and maintaining neurovascular supply to the fused segment. Thus, the features of CBT, which enhance screw fixation with limited surgical exposure, have attracted the interest of surgeons as a new minimally invasive method for spinal fusion.The purpose of this study was: 1) to identify the features of the CBT technique by reviewing previous anatomical and biomechanical literature, and 2) to describe its clinical application with a focus on the indications, limitations, surgical technique, and clinical evidence.

show abstract

Effect of pilot hole on biomechanical and in vivo pedicle screw–bone interface

Cited by 23 publications

References 41 publications

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Biomechanical evaluation of the fixation strength of lumbar pedicle screws using cortical bone trajectory: a finite element study

Pullout force comparison of selected screws for rigid fixation in maxillofacial surgery

Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints

Contact Info

Product

Resources

About