Bone density optimized pedicle screw insertion
Background: Spinal fusion is the most common surgical treatment for the management of degenerative spinal disease. However, complications such as screw loosening lead to painful pseudoarthrosis, and are a common reason for revision. Optimization of screw trajectories to increase implant resistance t...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1270522/full |
| _version_ | 1797648629314355200 |
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| author | Christos Tsagkaris Anna-Katharina Calek Anna-Katharina Calek Marie-Rosa Fasser Marie-Rosa Fasser José Miguel Spirig Sebastiano Caprara Sebastiano Caprara Mazda Farshad Mazda Farshad Jonas Widmer Jonas Widmer |
| author_facet | Christos Tsagkaris Anna-Katharina Calek Anna-Katharina Calek Marie-Rosa Fasser Marie-Rosa Fasser José Miguel Spirig Sebastiano Caprara Sebastiano Caprara Mazda Farshad Mazda Farshad Jonas Widmer Jonas Widmer |
| author_sort | Christos Tsagkaris |
| collection | DOAJ |
| description | Background: Spinal fusion is the most common surgical treatment for the management of degenerative spinal disease. However, complications such as screw loosening lead to painful pseudoarthrosis, and are a common reason for revision. Optimization of screw trajectories to increase implant resistance to mechanical loading is essential. A recent optimization method has shown potential for determining optimal screw position and size based on areas of high bone elastic modulus (E-modulus).Aim: The aim of this biomechanical study was to verify the optimization algorithm for pedicle screw placement in a cadaveric study and to quantify the effect of optimization. The pull-out strength of pedicle screws with an optimized trajectory was compared to that of a traditional trajectory.Methods: Twenty-five lumbar vertebrae were instrumented with pedicle screws (on one side, the pedicle screws were inserted in the traditional way, on the other side, the screws were inserted using an optimized trajectory).Results: An improvement in pull-out strength and pull-out strain energy of the optimized screw trajectory compared to the traditional screw trajectory was only observed for E-modulus values greater than 3500 MPa cm3. For values of 3500 MPa cm3 or less, optimization showed no clear benefit. The median screw length of the optimized pedicle screws was significantly smaller than the median screw length of the traditionally inserted pedicle screws, p < 0.001.Discussion: Optimization of the pedicle screw trajectory is feasible, but seems to apply only to vertebrae with very high E-modulus values. This is likely because screw trajectory optimization resulted in a reduction in screw length and therefore a reduction in the implant-bone interface. Future efforts to predict the optimal pedicle screw trajectory should include screw length as a critical component of potential stability. |
| first_indexed | 2024-03-11T15:34:46Z |
| format | Article |
| id | doaj.art-15e8919acc9e484fa647b42ffa2bd454 |
| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-03-11T15:34:46Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-15e8919acc9e484fa647b42ffa2bd4542023-10-26T22:08:54ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852023-10-011110.3389/fbioe.2023.12705221270522Bone density optimized pedicle screw insertionChristos Tsagkaris0Anna-Katharina Calek1Anna-Katharina Calek2Marie-Rosa Fasser3Marie-Rosa Fasser4José Miguel Spirig5Sebastiano Caprara6Sebastiano Caprara7Mazda Farshad8Mazda Farshad9Jonas Widmer10Jonas Widmer11Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandDepartment of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandInstitute for Biomechanics, ETH Zurich, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandInstitute for Biomechanics, ETH Zurich, Zurich, SwitzerlandDepartment of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandUniversity Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandSpine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, SwitzerlandInstitute for Biomechanics, ETH Zurich, Zurich, SwitzerlandBackground: Spinal fusion is the most common surgical treatment for the management of degenerative spinal disease. However, complications such as screw loosening lead to painful pseudoarthrosis, and are a common reason for revision. Optimization of screw trajectories to increase implant resistance to mechanical loading is essential. A recent optimization method has shown potential for determining optimal screw position and size based on areas of high bone elastic modulus (E-modulus).Aim: The aim of this biomechanical study was to verify the optimization algorithm for pedicle screw placement in a cadaveric study and to quantify the effect of optimization. The pull-out strength of pedicle screws with an optimized trajectory was compared to that of a traditional trajectory.Methods: Twenty-five lumbar vertebrae were instrumented with pedicle screws (on one side, the pedicle screws were inserted in the traditional way, on the other side, the screws were inserted using an optimized trajectory).Results: An improvement in pull-out strength and pull-out strain energy of the optimized screw trajectory compared to the traditional screw trajectory was only observed for E-modulus values greater than 3500 MPa cm3. For values of 3500 MPa cm3 or less, optimization showed no clear benefit. The median screw length of the optimized pedicle screws was significantly smaller than the median screw length of the traditionally inserted pedicle screws, p < 0.001.Discussion: Optimization of the pedicle screw trajectory is feasible, but seems to apply only to vertebrae with very high E-modulus values. This is likely because screw trajectory optimization resulted in a reduction in screw length and therefore a reduction in the implant-bone interface. Future efforts to predict the optimal pedicle screw trajectory should include screw length as a critical component of potential stability.https://www.frontiersin.org/articles/10.3389/fbioe.2023.1270522/fullpedicle screwtrajectoryspinesurgical planningspine biomechanics |
| spellingShingle | Christos Tsagkaris Anna-Katharina Calek Anna-Katharina Calek Marie-Rosa Fasser Marie-Rosa Fasser José Miguel Spirig Sebastiano Caprara Sebastiano Caprara Mazda Farshad Mazda Farshad Jonas Widmer Jonas Widmer Bone density optimized pedicle screw insertion Frontiers in Bioengineering and Biotechnology pedicle screw trajectory spine surgical planning spine biomechanics |
| title | Bone density optimized pedicle screw insertion |
| title_full | Bone density optimized pedicle screw insertion |
| title_fullStr | Bone density optimized pedicle screw insertion |
| title_full_unstemmed | Bone density optimized pedicle screw insertion |
| title_short | Bone density optimized pedicle screw insertion |
| title_sort | bone density optimized pedicle screw insertion |
| topic | pedicle screw trajectory spine surgical planning spine biomechanics |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1270522/full |
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