Journal article
Impaction grafting of lumbar pedicle defects: a biomechanical study of a novel technique for pedicle screw revision
JOURNAL OF NEUROSURGERY-SPINE, v 38(3)
Mar 2023
PMID: 36683188
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE The two most common revision options available for the management of loose pedicle screws are larger -diameter screws and cement augmentation into the vertebral body for secondary fixation. An alternative revision method is impaction grafting (pedicoplasty) of the failed pedicle screw track. This technique uses the impaction of corticocancel-lous bone into the pedicle and vertebral body through a series of custom funnels to reconstitute a new pedicle wall and a neomedullary canal. The goal of this study was to compare the biomechanics of screws inserted after pedicoplasty (impaction grafting) of a pedicle defect to those of an upsized screw and a cement-augmented screw.METHODS For this biomechanical cadaveric study the investigators used 10 vertebral bodies (L1-5) that were free of metastatic disease or primary bone disease. Following initial screw insertion, each screw was subjected to a pullout force that was applied axially along the screw trajectory at 5 mm per minute until failure. Each specimen was instrument-ed with a pedicoplasty revision using the original screw diameter, and on the contralateral side either a fenestrated screw with cement augmentation or a screw upsized by 1 mm was inserted in a randomized fashion. These revisions were then pulled out using the previously mentioned methods.RESULTS Initial screw pullout values for the paired upsized screw and pedicoplasty were 717 +/- 511 N and 774 +/- 414 N, respectively (p = 0.747) (n = 14). Revised pullout values for the paired upsized screw and pedicoplasty were 775 +/- 461 N and 762 +/- 320 N, respectively (p = 0.932). Initial pullout values for the paired cement augmentation and pedicoplasty were 792 +/- 434 N and 880 +/- 558 N, respectively (p = 0.649). Revised pullout values for the paired cement augmentation and pedicoplasty were 1159 +/- 300 N and 687 +/- 213 N, respectively (p < 0.001).CONCLUSIONS Pedicle defects are difficult to manage. Reconstitution of the pedicle and creation of a neomedullary ca- nal appears to be possible through the use of pedicoplasty. Biomechanically, screws that have been used in pedicoplasty have equivalent pullout strength to an upsized screw, and have greater insertional torques than those with the same diam-eter that have not been used in pedicoplasty, yet they are not superior to cement augmentation. This study suggests that although cement augmentation appears to have superior pullout force, the novel pedicoplasty technique offers promise as a viable biological revision option for the management of failed pedicle screws compared with the option of standard upsized screws in a cadaveric model. These findings will ultimately need to be further assessed in a clinical setting.
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Details
- Title
- Impaction grafting of lumbar pedicle defects: a biomechanical study of a novel technique for pedicle screw revision
- Publication Details
- JOURNAL OF NEUROSURGERY-SPINE, v 38(3)
- Publisher
- AMER ASSOC NEUROLOGICAL SURGEONS; ROLLING MEADOWS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000954403200004
- Scopus ID
- 2-s2.0-85149167421
- Other Identifier
- 991021860729504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery