Biomechanical analysis of the durability of a modified S1 vertebrae transpedicular screws insertion technique |
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| Affiliation: | 1. Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Lukasiewicza 7/9 Street, 50-371 Wrocław, Poland;2. Department of Orthopaedic and Traumatology, W. Dega University Hospital, 28 Czerwca 1956 r. 135/174 Street, 61-545 Poznań, Poland;3. Department of Human Anatomy, Medical University of Silesia, 18 Medyków Street, 40-762 Katowice, Poland;4. Department of Surgery, Wroclaw University of Environmental and Life Science, Pl. Grunwaldzki 51, 50-366 Wrocław, Poland;1. Department of Orthopaedic Surgery and Traumatology, CHU, Poitiers, France;2. Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France;3. Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, France;4. ABS Lab, Université de Poitiers, France;1. Département de Chirurgie Orthopédique Pédiatrique, CHU Angers, 4 rue Larrey, 49100 Angers, France;2. Institut régional du Cancer de Montpellier (ICM)- Val d''Aurelle, Montpellier, France;3. Laboratoire de Biochimie, Faculté de Pharmacie, 27 Boulevard Jean Moulin, 13005 Marseille, France;4. Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France;5. APHM, Hôpital Sainte Marguerite, IML, Marseille, France;6. Université Côte d''Azur, Univ Nice Sophia Antipolis, France;1. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan, Italy;2. Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, Milan, Italy;3. IRCCS San Raffaele Pisana, Via della Pisana, 235, Rome, Italy;4. University Center of Anápolis - Uni Evangélica, Anápolis, Goiás, Brazil |
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| Abstract: | BackgroundOne of the most important elements of the transpedicular screw implantation technique, which enables a strong screw-bone interface, is the precise choice of the site of screw insertion and the screw's trajectory. Due to the complex biomechanics of the lumbosacral interface and different shape of the sacrum, fixation of this segment remains a challenge for surgeons. Because of this, Kubaszewski et al. proposed a modified technique in which the entry point for screw insertion in the S1 vertebra is changed.MethodsSix human cadaver specimens of the S1 vertebrae were examined. Two transpedicular screws were inserted into the body of each examined vertebra using two implantation methods with different screw entry points and trajectories. The screws were subjected to cyclic preloading, followed by the pull-out test. The ultimate pull-out force, displacement, stiffness, and failure energy were measured.FindingsThe average pull-out force obtained for the standard method of implantation was 498 N (SD 201), whereas for the modified technique, it was 1308 N (SD 581). Displacement of the inserted screws in the new method was 36% higher than in the case of the standard method. This method is also characterized by the greater stiffness of the obtained interface and greater failure energy than the normally used technique.InterpretationThe obtained results demonstrate that the use of the new technique of implantation significantly increases the strength of the obtained screw-bone interface. It should also increase the success rate of the performed fixations and increase the safety of such fixations in clinical practice. |
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