Comparison of immediate anchoring effectiveness of two different techniques of bioresorbable ceramic application for pedicle screw augmentation
(2024) In Ceramics International- Abstract
Background: The application of a bioresorbable calcium sulfate/hydroxyapatite (CaS/HA) ceramic at the interface of fenestrated screws and osteoporotic bone significantly enhances the immediate mechanical anchorage compared with non-augmented controls. However, the anchoring effectiveness of different screw augmentation techniques in spines with varying vertebral bone mineral density (BMD) remains uncertain. Purpose: The aim of this study was to investigate the immediate anchoring effectiveness of CaS/HA augmentation with two different application techniques for pedicle screw fixation in spines with varying BMD levels. Methods: Two techniques were applied for pedicle screw augmentation: injecting CaS/HA through a cannulated pre-inserted... (More)
Background: The application of a bioresorbable calcium sulfate/hydroxyapatite (CaS/HA) ceramic at the interface of fenestrated screws and osteoporotic bone significantly enhances the immediate mechanical anchorage compared with non-augmented controls. However, the anchoring effectiveness of different screw augmentation techniques in spines with varying vertebral bone mineral density (BMD) remains uncertain. Purpose: The aim of this study was to investigate the immediate anchoring effectiveness of CaS/HA augmentation with two different application techniques for pedicle screw fixation in spines with varying BMD levels. Methods: Two techniques were applied for pedicle screw augmentation: injecting CaS/HA through a cannulated pre-inserted fenestrated screw (injecting technique) or delivering the material through a partly inserted screw to the predrilled bone canal before the screw was fully inserted (pre-filling technique). All thoracic and lumbar vertebrae from fresh-frozen cadaveric spine specimens of a non-osteoporotic elderly male and an osteoporotic elderly female were collected. The injecting and pre-filling techniques were applied to the left and right sides of each individual vertebra, with 1 mL and 2 mL of CaS/HA paste per unilateral thoracic and lumbar screw, respectively. X-rays and CT scans were applied to monitor the procedures and the cement distribution of the augmented screws. Finally, all vertebrae were subjected to uniaxial pull-out testing. Results: The CaS/HA was effectively distributed around the screws in all vertebrae. The maximum pull-out force was comparable between the techniques in both non-osteoporotic and osteoporotic spines, while the pull-out force was significantly higher in the non-osteoporotic spine compared with the osteoporotic spine, regardless of the augmentation technique applied. Conclusion: The application of CaS/HA augmented cannulated or fenestrated pedicle screws, regardless of the augmentation technique employed, resulted in similar initial anchorage strength in both non-osteoporotic and osteoporotic spine. The vertebral BMD will determine the absolute maximum pull-out strength of the augmented screws.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- Biomaterial, Biomechanical, Bone mineral density, Calcium sulfate/hydroxyapatite, Ceramic, Pedicle screw augmentation
- in
- Ceramics International
- publisher
- Elsevier
- external identifiers
-
- scopus:85183102145
- ISSN
- 0272-8842
- DOI
- 10.1016/j.ceramint.2024.01.195
- language
- English
- LU publication?
- yes
- id
- 181e4250-a622-48b9-b1e4-908364dd7927
- date added to LUP
- 2024-02-19 15:04:46
- date last changed
- 2024-02-19 15:05:54
@article{181e4250-a622-48b9-b1e4-908364dd7927,
abstract = {{<p>Background: The application of a bioresorbable calcium sulfate/hydroxyapatite (CaS/HA) ceramic at the interface of fenestrated screws and osteoporotic bone significantly enhances the immediate mechanical anchorage compared with non-augmented controls. However, the anchoring effectiveness of different screw augmentation techniques in spines with varying vertebral bone mineral density (BMD) remains uncertain. Purpose: The aim of this study was to investigate the immediate anchoring effectiveness of CaS/HA augmentation with two different application techniques for pedicle screw fixation in spines with varying BMD levels. Methods: Two techniques were applied for pedicle screw augmentation: injecting CaS/HA through a cannulated pre-inserted fenestrated screw (injecting technique) or delivering the material through a partly inserted screw to the predrilled bone canal before the screw was fully inserted (pre-filling technique). All thoracic and lumbar vertebrae from fresh-frozen cadaveric spine specimens of a non-osteoporotic elderly male and an osteoporotic elderly female were collected. The injecting and pre-filling techniques were applied to the left and right sides of each individual vertebra, with 1 mL and 2 mL of CaS/HA paste per unilateral thoracic and lumbar screw, respectively. X-rays and CT scans were applied to monitor the procedures and the cement distribution of the augmented screws. Finally, all vertebrae were subjected to uniaxial pull-out testing. Results: The CaS/HA was effectively distributed around the screws in all vertebrae. The maximum pull-out force was comparable between the techniques in both non-osteoporotic and osteoporotic spines, while the pull-out force was significantly higher in the non-osteoporotic spine compared with the osteoporotic spine, regardless of the augmentation technique applied. Conclusion: The application of CaS/HA augmented cannulated or fenestrated pedicle screws, regardless of the augmentation technique employed, resulted in similar initial anchorage strength in both non-osteoporotic and osteoporotic spine. The vertebral BMD will determine the absolute maximum pull-out strength of the augmented screws.</p>}},
author = {{Tian, Xinggui and Raina, Deepak Bushan and Oberländer, Jan Teja and Liu, Yang and Goronzy, Jens and Apolle, Rudi and Vater, Corina and Richter, Richard Frank and Tägil, Magnus and Lidgren, Lars and Thomas, Alexander and Platz, Uwe and Schaser, Klaus Dieter and Disch, Alexander C. and Zwingenberger, Stefan}},
issn = {{0272-8842}},
keywords = {{Biomaterial; Biomechanical; Bone mineral density; Calcium sulfate/hydroxyapatite; Ceramic; Pedicle screw augmentation}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Ceramics International}},
title = {{Comparison of immediate anchoring effectiveness of two different techniques of bioresorbable ceramic application for pedicle screw augmentation}},
url = {{http://dx.doi.org/10.1016/j.ceramint.2024.01.195}},
doi = {{10.1016/j.ceramint.2024.01.195}},
year = {{2024}},
}