The effect of dilation of immature pedicles on pullout strength of the screws: Part 2: In vivo study.

Abstract:

STUDY DESIGN:Experimental study. OBJECTIVE:To evaluate the biomechanical stability of screws placed in expanded pedicles, and to compare those with the screws placed in the nonexpanded pedicles in an in vivo model. SUMMARY OF BACKGROUND DATA:Pullout strength of a pedicle screw increases as the diameter of the screw gets larger. Small pedicles of pediatric patients prevent the use of large size pedicle screws in this age group. As shown in an in vitro study one option to overcome this problem is to dilate and use larger screw in immature spine. But dilation reduces the pullout strength of pedicle screws in in vitro model. METHODS:Six-week-old 3 pigs were used. One of them was lost in the postoperative period. After posterior subperiosteal exposure of lumbar segments (L1-L5), 4.0 mm diameter and 20 mm long pedicle screws were placed on the left. The right pedicles were dilated with stainless steel dilators and instrumented with screws of same dimension. At the end of 3 months the pigs were killed and the pull out strength of each screw were measured. RESULTS:The average pull out strength of the expanded and nonexpanded screws was 378.7 +/- 73 (542-308) Newton and 397 +/- 80 (535-289) Newton, respectively. There was no statistically significant difference between the 2 groups. CONCLUSION:The biomechanical stability of the same size screws inserted at the expanded and nonexpanded pedicles are the same after 3 months. Even dilation of the pedicle decreases the pullout strength of the screw at the beginning, and the pull out strength of both sides became equal after 3 months. The remodeling capacity of pedicles and overgrowth of bone on screws may have an effect on this result.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Yilmaz G,Demirkiran G,Ozkan C,Daglioglu K,Pekmezci M,Alanay A,Yazici M

doi

10.1097/BRS.0b013e3181b0bb9b

subject

Has Abstract

pub_date

2009-10-15 00:00:00

pages

2378-83

issue

22

eissn

0362-2436

issn

1528-1159

pii

00007632-200910150-00004

journal_volume

34

pub_type

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