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09.06.2018 | Original Article

Time to augment?! Impact of cement augmentation on pedicle screw fixation strength depending on bone mineral density

verfasst von: Lukas Weiser, Gerd Huber, Kay Sellenschloh, Lennart Viezens, Klaus Püschel, Michael M. Morlock, Wolfgang Lehmann

Erschienen in: European Spine Journal | Ausgabe 8/2018

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Abstract

Purpose

Cement augmentation of pedicle screws is known to increase their mechanical strength. Aim was to evaluate the impact of cement augmentation on pedicle screw fatigue strength in dependence of the bone mineral density (BMD).

Methods

Twenty-one human L2 vertebral bodies from donors between 19 and 96 years of age were used for in vitro experiments. BMD was measured using quantitative computed tomography (QCT). Two pedicle screws were inserted in each specimen and unilaterally augmented with bone cement. Fatigue testing was performed using a cranio-caudal sinusoidal, cyclic load (0.5 Hz) with increasing compression force (100 N + 0.1 N/cycles). Results were evaluated for the BMD groups: normal: BMD > 120 mg/cm³, osteopenic: BMD 80–120 mg/cm³, and osteoporotic: BMD < 80 mg/cm³ bone mass.

Results

There was a significant correlation between fatigue force and BMD for the non-augmented and augmented screws (non-augmented R² = 0.839, p < 0.001; augmented R² = 0.551, p < 0.001). There was a significantly increased fatigue strength of the augmented screws over the non-augmented screws in the osteoporotic group (p = 0.001), while the differences in the other groups were not significant (normal p = 0.818/osteopenic p = 0.132).

Conclusions

The benefit of pedicle screw cement augmentation significantly depends on the bone mineral density and has the greatest extent of increased fatigue strength in osteoporotic vertebrae. Preoperative measurement of the BMD is strongly recommended to predict the benefit of augmentation and reinforce the decision for cement augmentation.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Titel: Time to augment?! Impact of cement augmentation on pedicle screw fixation strength depending on bone mineral density
verfasst von: Lukas Weiser
Gerd Huber
Kay Sellenschloh
Lennart Viezens
Klaus Püschel
Michael M. Morlock
Wolfgang Lehmann
Publikationsdatum: 09.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 8/2018
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5660-7

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