Rescue Augmentation: Increased Stability in Augmentation After Initial Loosening of Pedicle Screws
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Rescue Augmentation: Increased Stability in Augmentation After Initial Loosening of Pedicle Screws. / Weiser, Lukas; Huber, Gerd; Sellenschloh, Kay; Püschel, Klaus; Morlock, Michael M; Viezens, Lennart; Lehmann, Wolfgang.
in: GLOB SPINE J, Jahrgang 11, Nr. 5, 06.2021, S. 679-685.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Rescue Augmentation: Increased Stability in Augmentation After Initial Loosening of Pedicle Screws
AU - Weiser, Lukas
AU - Huber, Gerd
AU - Sellenschloh, Kay
AU - Püschel, Klaus
AU - Morlock, Michael M
AU - Viezens, Lennart
AU - Lehmann, Wolfgang
PY - 2021/6
Y1 - 2021/6
N2 - STUDY DESIGN: Biomechanical study.OBJECTIVES: Failure of pedicle screws is a major problem in spinal surgery not only postoperatively, but also intraoperatively. The aim of this study was to evaluate whether cement augmentation may restore mounting of initially loosened pedicle screws.METHODS: A total of 14 osteoporotic or osteopenic human cadaveric vertebral bodies (L2)-according to quantitative computed tomography (QCT)-were instrumented on both sides by conventional pedicle screws and cement augmented on 1 side. In vitro fatigue loading (cranial-caudal sinusoidal, 0.5 Hz) with increasing peak force (100 N + 0.1 N/cycles) was applied until a screw head displacement of 5.4 mm (∼20°) was reached. After loosening, the nonaugmented screw was rescue augmented, and fatigue testing was repeated.RESULTS: The fatigue load reached 207.3 N for the nonaugmented screws and was significantly (P = .009) exceeded because of initial cement augmentation (300.6 N). The rescue augmentation after screw loosening showed a fatigue load of 370.1 N which was significantly higher (P < .001) compared with the nonaugmented screws. The impact of bone density on fatigue strength decreased from the nonaugmented to the augmented to the rescue-augmented screws and shows the greatest effect of cement augmentation on fatigue strength at low bone density.CONCLUSIONS: Rescue augmentation leads to similar or higher fatigue strengths compared with those of the initially augmented screws. Therefore, the cement augmentation of initially loosened pedicle screws is a promising option to restore adequate screw stability.
AB - STUDY DESIGN: Biomechanical study.OBJECTIVES: Failure of pedicle screws is a major problem in spinal surgery not only postoperatively, but also intraoperatively. The aim of this study was to evaluate whether cement augmentation may restore mounting of initially loosened pedicle screws.METHODS: A total of 14 osteoporotic or osteopenic human cadaveric vertebral bodies (L2)-according to quantitative computed tomography (QCT)-were instrumented on both sides by conventional pedicle screws and cement augmented on 1 side. In vitro fatigue loading (cranial-caudal sinusoidal, 0.5 Hz) with increasing peak force (100 N + 0.1 N/cycles) was applied until a screw head displacement of 5.4 mm (∼20°) was reached. After loosening, the nonaugmented screw was rescue augmented, and fatigue testing was repeated.RESULTS: The fatigue load reached 207.3 N for the nonaugmented screws and was significantly (P = .009) exceeded because of initial cement augmentation (300.6 N). The rescue augmentation after screw loosening showed a fatigue load of 370.1 N which was significantly higher (P < .001) compared with the nonaugmented screws. The impact of bone density on fatigue strength decreased from the nonaugmented to the augmented to the rescue-augmented screws and shows the greatest effect of cement augmentation on fatigue strength at low bone density.CONCLUSIONS: Rescue augmentation leads to similar or higher fatigue strengths compared with those of the initially augmented screws. Therefore, the cement augmentation of initially loosened pedicle screws is a promising option to restore adequate screw stability.
U2 - 10.1177/2192568220919123
DO - 10.1177/2192568220919123
M3 - SCORING: Journal article
C2 - 32875910
VL - 11
SP - 679
EP - 685
JO - GLOB SPINE J
JF - GLOB SPINE J
SN - 2192-5682
IS - 5
ER -