Calcium sulfate cement augments transient stability of pedicle screw in osteoporotic vertebral body

doi:10.3969/j.issn.2095-4344.2014.26.018

Abstract

Abstract:

BACKGROUND: Poor implant anchorage in osteoporotic bone impacts its stability and requires the new solutions for the treatment. The augmentation technique with bone cements or bone substitutes is one strategy for the solutions.
OBJECTIVE: To evaluate the transient stability of pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body.
METHODS: Fresh calf lumbar vertebrae were selected to measure bone density, and then classified into four groups: the group by pedicle screw in normal vertebral body; the group by pedicle screw augmented using calcium sulfate cement in normal vertebral body; the group by pedicle screw in osteoporotic vertebral body; the group by pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body. Pedicle screw of equal specification was twisted into the tested pedicle of vertebral arch. The maximum axial screw pull-out strength and the maximum energy required to failure were recorded so as to assess the transient stability of pedicle screw augmented using calcium sulfate cement.
RESULTS AND CONCLUSION: The maximum screw pull-out strength and the maximum energy required to failure were significantly less in osteoporotic vertebral body compared with normal vertebral body (P < 0.05). The maximum screw pull-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were significantly increased (P < 0.05). The maximum screw pull-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were identical between normal group and osteoporosis group. These results suggested that calcium sulfate cement could effectively increase the transient stability of pedicle screw. Calcium sulfate cement is effective in augmenting fixation in osteoporotic bone, and has potential in clinical application.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: osteoporosis, internal fixators, calcium sulfate, biomechanics

CLC Number:

R318

Zhu Ai-guo, Zhang Feng, Ge Yong, Cao Yong, Zhang Chi, Chen Yun. Calcium sulfate cement augments transient stability of pedicle screw in osteoporotic vertebral body[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(26): 4195-4199.

Figures/Tables 3

References

[1]Kannus P, Niemi S, Parkkari J, et al. Why is the age-standardized incidence of low-trauma fractures rising in many elderly populations? J Bone Miner Res. 2002;17(8): 1363-1367.
[2]Curtis R, Goldhahn J, Schwyn R, et al. Fixation principles in metaphyseal bone--a patent based review. Osteoporos Int. 2005;16 Suppl 2:S54-64.
[3]曹涌,张烽,姚羽,等.快速建立小牛椎体骨质疏松模型[J].中国组织工程研究与临床康复,2011,15(39):7288-7291.
[4]Kawagoe K, Saito M, Shibuya T, et al. Augmentation of cancellous screw fixation with hydroxyapatite composite resin (CAP) in vivo. J Biomed Mater Res. 2000;53(6):678-684.
[5]Koval KJ, Meek R, Schemitsch E, et al. An AOA critical issue. Geriatric trauma: young ideas. J Bone Joint Surg Am. 2003; 85-A(7):1380-1388.
[6]Augat P, Simon U, Liedert A, et al. Mechanics and mechano-biology of fracture healing in normal and osteoporotic bone. Osteoporos Int. 2005;16 Suppl 2:S36-43.
[7]Meyer RA Jr, Tsahakis PJ, Martin DF, et al. Age and ovariectomy impair both the normalization of mechanical properties and the accretion of mineral by the fracture callus in rats. J Orthop Res. 2001;19(3):428-435.
[8]Bergman RJ, Gazit D, Kahn AJ, et al. Age-related changes in osteogenic stem cells in mice. J Bone Miner Res. 1996;11(5): 568-577.
[9]汤亭亭,岳冰,陆斌,等.年龄因素对大鼠骨髓间充质干细胞数量及组织中BMP2含量的影响[J].中国骨质疏松杂志,2005, 11(2): 156-158.
[10]Seebeck J, Goldhahn J, Morlock MM, et al. Mechanical behavior of screws in normal and osteoporotic bone. Osteoporos Int. 2005;16 Suppl 2:S107-111.
[11]Perren SM. Backgrounds of the technology of internal fixators. Injury. 2003;34 Suppl 2:B1-3.
[12]Turner IG, Rice GN. Comparison of bone screw holding strength in healthy bovine and osteoporotic human cancellous bone. Clin Mater. 1992;9(2):105-107.
[13]von der Linden P, Gisep A, Boner V, et al. Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures. J Orthop Res. 2006;24(12):2230-2237.
[14]Lieberman IH, Togawa D, Kayanja MM. Vertebroplasty and kyphoplasty: filler materials. Spine J. 2005;5(6 Suppl): 305-316S.
[15]Jansen J, Ooms E, Verdonschot N, et al. Injectable calcium phosphate cement for bone repair and implant fixation. Orthop Clin North Am. 2005;36(1):89-95.
[16]Oda H, Nakamura K, Matsushita T, et al. Clinical use of a newly developed calcium phosphate cement (XSB-671D). J Orthop Sci. 2006;11(2):167-174.
[17]Peters CL, Hines JL, Bachus KN, et al. Biological effects of calcium sulfate as a bone graft substitute in ovine metaphyseal defects. J Biomed Mater Res A. 2006;76(3): 456-462.
[18]Valimaki VV, Aro HT. Molecular basis for action of bioactive glasses as bone graft substitute. Scand J Surg. 2006;95(2): 95-102.
[19]Larsson S. Cement augmentation in fracture treatment. Scand J Surg. 2006;95(2):111-118.
[20]Carroll M, Lewis G, Xu J, et al. Evaluation of a synthetic bone defect test model to aid in the selection of materials for use in vertebral body compression fracture repair. Orthopedics. 2004; 27(1 Suppl):s119-122.