Study Design. Biomechanical parameters affecting the strength of screw
-to-bone fixations of ventral cervical spondylodeses were determined.
Objectives. The rate of implant loosening with ventral cervical spondy
lodeses is high. Types of failure and how they can be avoided are pres
ented. Summary of Background Data. The number of sound studies on corr
esponding thoraco-lumbar spinal implants is large. However, no compara
tive study has been published thus far covering the strength of screw-
to-bone fixation in the cervical region. Methods. Human cervical verte
brae were obtained at autopsy. Their bone mineral density related to c
alcium-hydroxyapatite was determined by single energy quantitative com
puted tomography scan. Standard cancellous screws with a diameter of 3
.5 mm and 4.5 mm ''rescue'' screws were screwed down to failure into 4
3 single vertebral bodies. The applied torque T and the resultant axia
l force F-ax at the ''washer's'' position were measured simultaneously
by a specially designed electronic testing machine. Results. A strong
correlation among F-ax, T, and bone mineral density aws found (0.4636
< r < 0.7545). Application of standard screws reveals that F-ax and T
linearly respond to the effective thread length, whether the posterio
r vertebral cortex is engaged or not (paired t test: P < 0.05, n = 38)
. When ''rescue'' screws are used and the posterior vertebral cortex i
s included, a significantly higher torque T must be applied to achieve
the same revolution. Surprisingly, the resulting force F-ax hardly al
ters. If under similar circumstances the posterior vertebral cortex is
not included in the construct, F-ax is significantly lower (paired t
test: P < 0.05, n = 32). A stable fixation of 3.5 mm screws cannot be
achieved if bone mineral density remains below 150 mg/ml. Conclusions.
Thus, determining bone mineral density before surgery by quantitative
computed tomography is recommended to ensure a proper selection of sc
rew type and thereby increase the success of surgical fixation.