Ultrasound melted polymer sleeve for improved primary pedicle screw anchorage: A novel augmentation technique |
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| Affiliation: | 1. Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria;2. Nexilis AG, Liestal, Switzerland;3. Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria;1. Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea;2. Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA;3. Department of Orthopaedic Surgery, University of California, Irvine, CA, USA;4. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan;5. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Seoul, Republic of Korea;1. Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland;2. Pneumology Department, Parc de Salut Mar-IMIM-UPF CIBERES (ISC iii), Barcelona, Spain;3. Emergency Department, Parc de Salut Mar, Barcelona, Spain;4. Laboratory Medicine, University Hospital Basel, Switzerland;5. Emergency Department, Kantonsspital Luzern, Switzerland.;1. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia;2. ANZAC Research Institute, The University of Sydney, Sydney, Australia;3. Department of Cardiology, Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia;4. Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia;1. Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Sungnam, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea;2. Department of Orthopaedic Surgery, Spine Center, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea |
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| Abstract: | BackgroundCement augmentation of pedicle screws to prevent screw loosening is associated with significant complications, such as cement leakage or bone necrosis. Therefore, an alternative strategy to improve pedicle screw anchorage has been recently developed: Polymer reinforcement of pedicle screws uses an in situ melted polymer sleeve in order to enhance screw anchorage. This biomechanical study evaluated the effect of polymer-reinforcement by comparing polymer-reinforced pedicle screws to non-augmented as well as cement-augmented screws under cyclic loading.MethodsFor each of the two comparisons (polymer-reinforced vs. non-augmented screws and polymer-reinforced vs. cement-augmented screws), polymer-reinforced screws and control screws were placed into the left and right pedicle of seven vertebrae (mean age: 74.0 (SD 9.3) years) to allow for pairwise left–right comparisons. Each screw was subjected to cyclic cranio-caudal loading with an initial load ranging from −50 N to +50 N and with stepwise increasing compressive loads (5 N every 100 cycles) until screw loosening.FindingsPolymer-reinforced pedicle screws resisted a higher number of load cycles until loosening than the contralateral non-augmented control screws (4300 SD 2018 vs. 2457 SD 1116 load cycles, p = 0.015). Screw anchorage of polymer-reinforced pedicle screws was comparable to that of cement augmented control screws (3857 (SD2085) vs. 4300 (SD1257) load cycles until failure, p = 0.64).InterpretationOur findings indicate that polymer-reinforcement significantly enhances pedicle screw anchorage in low quality bone and that its effect is similar in size than that of cement augmentation. |
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