Journal of Biomedical Engineering Research (대한의용생체공학회:의공학회지)

The Korean Society of Medical and Biological Engineering (대한의용생체공학회)
권호 표지
DOI QR코드

DOI QR Code

A Study on Pullout Characteristics of Pedicle Screw Design Considering Anatomical Structure of the Lumbar Spine

척추의 해부학적 요소를 고려한 척추경 나사못 디자인의 Pullout 특성 연구

  • 유경주 ((주)지비에스커먼웰스 기술연구소) ;
  • 박광민 (충북대학교 의용생체공학과) ;
  • 안경기 ((주)지비에스커먼웰스 기술연구소) ;
  • 안윤호 ((주)지비에스커먼웰스 기술연구소)
  • Received : 2020.12.18
  • Accepted : 2021.01.05
  • Published : 2021.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Recently, various types of pedicle screws have been developed considering the anatomical structure of the spine. The purpose of this study was to evaluate the pullout stiffness and strength of two types of commercial pedicle screws. The design of two type screws were single pitched thread (ST) pedicle screw and dual pitched thread (DT) pedicle screw, respectively. The tests were conducted in accordance with the ASTM standards using polyurethane (PU) test blocks which has anatomical structure of the spine. There was no significant difference in pullout stiffness between two types of screw. However, DT exhibited higher pullout strength than ST (p<0.05). Pedicle screw with dual pitched thread showed higher pullout strength without decrease in pullout stiffness compared to the standard pedicle screw. In conclusion, dual pitched thread design of the pedicle screw is considered to be more suitable than the single pitched thread for the anatomical structure of the spine.

Keywords

References

  1. Boucher HH. A method of spinal fusion. J Bone Joint Surg Br. 1959;41:248-59. https://doi.org/10.1302/0301-620X.41B2.248
  2. Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res. 1988;227: 10-23.
  3. Inceoglu S, Ehlert M, Akbay A, McLain RF. Axial cyclic behavior of the bone-screw interface. Med Eng Phys. 2006; 28(9):888-93. https://doi.org/10.1016/j.medengphy.2005.12.009
  4. McAfee PC, Weiland DJ, Carlow JJ. Survivorship analysis of pedicle spinal instrumentation. Spine. 1991;16(8):422-7. https://doi.org/10.1097/00007632-199104000-00005
  5. Lonstein JE, Denis F, Perra JH, Smith MR, Winter RB. Complications associated with pedicle screws. J Bone Joint Surg Am. 1999;81(11):1519-28. https://doi.org/10.2106/00004623-199911000-00003
  6. DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65. Surgical considerations and treatment options in patients with poor bone quality. Spine. 2006;31(19):144-51.
  7. Ponnusamy KE, Iyer S, Gupta G, Khanna AJ. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J. 2011;11(1):54-63. https://doi.org/10.1016/j.spinee.2010.09.024
  8. Giacaglia GEO, Lamas WQ. Pedicle screw rupture: A case study. Case Studies in Engineering Failure Analysis. 2015;4:64-75. https://doi.org/10.1016/j.csefa.2015.09.001
  9. Cook SD, Salkeld SL, Whitecloud III TS, Barbera J. Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord. 2000;13(3): 230-6. https://doi.org/10.1097/00002517-200006000-00006
  10. Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J. 2005;15(3):321-6. https://doi.org/10.1007/s00586-004-0867-1
  11. Becker S, Chavanne A, Spitaler R, Kropik K, Aigner N, Ogon M, Redl H. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J. 2008;17(11):1462-9. https://doi.org/10.1007/s00586-008-0769-8
  12. Kim YY, Choi WS, Rhyu KW. Assessment of pedicle screw pullout strength based on various screw designs and bone densities-an ex vivo biomechanical study. Spine J. 2012;12(2): 164-8. https://doi.org/10.1016/j.spinee.2012.01.014
  13. Yaman O, Demir T, Arslan AK, Iyidiker MA, Tolunay T, Camuscu N, Ulutas M. The comparison of pullout strengths of various pedicle screw designs on synthetic foams and ovine vertebrae. Turk Neurosurg. 2015;25(4):532-8.
  14. Choi SG, Cha EJ, Kim KA, Ahn YH. Mechanical performance comparison of pedicle screw based on design parameters: dual lead and dual pitch. Journal of Biomedical Engineering Research. 2018;39:134-9. https://doi.org/10.9718/JBER.2018.39.3.134
  15. ASTM Standards, F1839-08(2016), Standard Specification for Rigid Polyurethane Foam for Use as a Standard Material for Testing Orthopaedic Devices and Instruments. 2016.
  16. ASTM Standards, F543-17, Standard Specification and Test Methods for Metallic Medical Bone Screws. 2017.
  17. Abshire BB, McLain RF, Valdevit A, Kambic HE Characteristics of pullout failure in conical and cylindrical pedicle screws after full insertion and back-out. Spine J. 2001;1(6):408-14. https://doi.org/10.1016/S1529-9430(01)00119-X
  18. Ono A, Brown MD, Lattal LL, Milne EL, Holmes DC. Triangulated pedicle screw construct technique and pull-out strength of conical and cylindrical screws. J Spinal Disord. 2001;14(3):323-9. https://doi.org/10.1097/00002517-200108000-00007
  19. Kwok AW, Finkelstein JA, Woodside T, Hearn TC, Hu RW. Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone. Spine. 1996;21(21):2429-34. https://doi.org/10.1097/00007632-199611010-00004
  20. Brasiliense LB, Lazaro BC, Reyes PM, Newcomb AG, Turner JL, Crandall DG, Crawford NR. Characteristics of immediate and fatigue strength of a dual-threaded pedicle screw in cadaveric spines. Spine J. 2013;13(8):947-56. https://doi.org/10.1016/j.spinee.2013.03.010
  21. Sevastik B, Xiong B, Sevastik J, Hedlund R, Suliman I. Vertebral rotation and pedicle length asymmetry in the normal adult spine. Eur Spine J. 1995;4(2):95-7. https://doi.org/10.1007/BF00278919
  22. Krenn MH, Piotrowski WP, Penzkofer R. Influence of thread design on pedicle screw fixation. J Neurosurg Spine. 2008;9: 90-5. https://doi.org/10.3171/SPI/2008/9/7/090
  23. Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC. Failure analysis of broken pedicle screws on spinal instrumentation. Med Eng Phys. 2005;27(6):487-96. https://doi.org/10.1016/j.medengphy.2004.12.007
  24. Inceoglu S, Kilincer C, Tami A, McLain RF. Cortex of the pedicle of the vertebral arch. Part I: Deformation characteristics during screw insertion. J Neurosurg Spine. 2007;7(3):341-6. https://doi.org/10.3171/SPI-07/09/341
  25. Vafadar S, Rouhi G. The effects of geometrical parameters of the pedicle screw on its pullout strength: In-vitro animal tests. J Orthop Spine Trauma. 2007;3(4):e74189.