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Publisher DOI: 10.1007/s00586-020-06376-w
Title: Reduced cement volume does not affect screw stability in augmented pedicle screws
Language: English
Authors: Weiser, Lukas 
Sellenschloh, Kay 
Püschel, Klaus 
Morlock, Michael 
Viezens, Lennart 
Lehmann, Wolfgang 
Huber, Gerd 
Keywords: Bone mineral density; CAPSI; Cement augmentation; Cement volume; Pedicle screw
Issue Date: 23-Mar-2020
Publisher: Springer
Source: European Spine Journal 6 (29): 1297-1303 (2020-06-01)
Abstract (english): 
Purpose: Cement augmentation of pedicle screws is able to improve screw anchorage in osteoporotic vertebrae but is associated with a high complication rate. The goal of this study was to evaluate the impact of different cement volumes on pedicle screw fatigue strength. Methods: Twenty-five human vertebral bodies (T12–L4) were collected from donors between 73 and 97 years of age. Bone density (BMD) was determined by quantitative computed tomography. Vertebral bodies were instrumented by conventional pedicle screws, and unilateral cement augmentation was performed. Thirteen vertebrae were augmented with a volume of 1 ml and twelve with a volume of 3 ml bone cement. A fatigue test was performed using a cranial–caudal sinusoidal, cyclic load (0.5 Hz) with increasing compression force (100 N + 0.1 N/cycles). Results: The load to failure was 183.8 N for the non-augmented screws and was increased significantly to 268.1 N (p < 0.001) by cement augmentation. Augmentation with 1 ml bone cement increased the fatigue load by 41% while augmentation with 3 ml increased the failure load by 51% compared to the non-augmented screws, but there was no significant difference in fatigue loads between the specimens with screws augmented with 1 ml and screws augmented with 3 ml of bone cement (p = 0.504). Conclusion: Cement augmentation significantly increases pedicle screw stability. The benefit of augmentation on screw anchorage was not significantly affected by reducing the applied volume of cement from 3 ml to 1 ml. Considering the high risk of cement leakage during augmentation, we recommend the usage of a reduced volume of 1 ml bone cement for each pedicle screw. Graphic Abstract: These slides can be retrieved under Electronic Supplementary Material [Figure not available: see fulltext.].
DOI: 10.15480/882.2804
ISSN: 0940-6719
Journal: European spine journal 
Institute: Biomechanik M-3 
Document Type: Article
More Funding information: Open Access funding provided by Projekt DEAL.
License: CC BY 4.0 (Attribution) CC BY 4.0 (Attribution)
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