Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design

The advantages of pedicle screw fixation depend on their ability to retain bony purchase until the fusion mass is stable. Osteoporotic bone and remova l and replacement of pedicle screws in revision procedures substantially re duce screw mechanical fixation strength and can lead to clinical failure. T he objective of this study was to determine if an expansive pedicle screw d esign could be used to improve biomechanical fixation in bone of compromise d quality. Axial mechanical pullout testing was performed on paired expansi ve and conventional pedicle screws placed in fresh, unembalmed cadaveric ve rtebrae. Bone mineral density measurements (made using a dual-energy X-ray absorption meter) were used to characterize bone quality. A preliminary cli nical and radiographic evaluation of 14 patients was also performed at a mi nimum 2-year follow-up. The mean axial pullout force in bone of all qualiti es was increased 30% when the expansive pedicle screw design was used. This included an appropriate 50% increase in pullout force in bone of poor qual ity (low bone mineral density). The preliminary clinical and radiographic r esults were supportive of the biomechanical design rationale and mechanical testing. The results were similar to those expected for spinal instrumenta tion using pedicle screws, even though compromised bone was present in two thirds of the cases in which the expansive screw was used.