Cortical bone trajectory screws used to save failed traditional trajectory screws in the osteoporotic lumbar spine and vice versa: a human cadaveric biomechanical study

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OBJECTIVE

Traditional trajectory (TT) screws are widely used in lumbar fixation. However, they may require revision surgery in some instances, especially in patients with osteoporotic spines. Cortical bone trajectory (CBT) screws may potentially be used to rescue a failed TT screw and vice versa in nonosteoporotic spines. This study aimed to investigate whether a CBT screw can salvage a compromised TT screw in osteoporotic lumbar spines and vice versa.

METHODS

A total of 42 vertebrae from 17 cadaveric lumbar spines were obtained. Bone mineral density was measured, and a CBT screw was randomly inserted into one side of each vertebra. A TT screw was then inserted into the contralateral side. The biomechanical properties of the screws were tested to determine their insertional torque, pullout strength, and fatigue performance. After checking the screws for the failure of each specimen, the failed screw track was salvaged with a screw of the opposite trajectory. The specimen was then subjected to the same mechanical tests, and results were recorded. A repeat pullout test on TT and CBT screws was also performed.

RESULTS

When CBT screws were used to rescue failed TT screws, the original torque increased by 50%, an average of 81% of the pullout strength of the initial TT screws was retained, and the fatigue performance was equal to that of the original screws, which were considerably stronger than the loose TT screws—that is, the TT repeat screws/TT screws were 33% of the pullout strength of the initial TT screws. When the TT screws were used to salvage the compromised CBT screws, the TT screws retained 51% of the original torque and 54% of the original pullout strength, and these screws were still stronger than the loose CBT screws—that is, the loose CBT screws retained 12% pullout strength of the initial CBT screws. Fatigue performance and the ratio of the pullout strength considerably decreased between the CBT rescue screws and the original CBT screws but slightly changed between the TT rescue screws and the original TT screws.

CONCLUSIONS

CBT and TT screws can be applied in a revision technique to salvage each other in osteoporotic lumbar spines. Additionally, CBT and TT screws each retain adequate insertional torque, pullout strength, and fatigue performance when used for revision in osteoporotic lumbar spines.

ABBREVIATIONS BMD = bone mineral density; CBT = cortical bone trajectory; DEXA = dual-energy x-ray absorptiometry; PIH = pedicle isthmus height; PIW = pedicle isthmus width; PMMA = polymethylmethacrylate; TT = traditional trajectory.

Article Information

Correspondence Cai-Liang Shen: The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. shencailiang1616@163.com.

INCLUDE WHEN CITING Published online March 8, 2019; DOI: 10.3171/2018.12.SPINE18970.

R.J.Z. and H.M.L. contributed equally to this work and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Experimental setups of the pullout test (A) and cyclic fatigue test (B). Load cell (L), 5.5 × 110–mm titanium rod (R), fixation device (F), and specimen (S) are shown. Figure is available in color online only.

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    Maximum insertional torques of 4 screw types and their comparison. Error bars indicate SD. *p < 0.05, **p < 0.001. Figure is available in color online only.

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    Ratios of pullout load and insertional torque. Error bars indicate SD. **p < 0.001. Figure is available in color online only.

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    Pullout loads of 4 screw types and their comparison. Error bars indicate SD. **p < 0.001. Figure is available in color online only.

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    A: Bone density did not significantly correlate with the ratio of CBT rescue screw pullout strength to that of the original CBT screws. B: Ratio of pullout strength of the TT rescue screws to that of the original TT screws significantly increased with a declining bone density.

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