Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading
Purpose Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic...
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| Veröffentlicht in: | European spine journal 2018-08, Vol.27 (8), p.1775-1784 |
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| creator | Lindtner, Richard A. Schmid, Rene Nydegger, Thomas Konschake, Marko Schmoelz, Werner |
| description | Purpose
Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws.
Methods
In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm
3
± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm
3
± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from − 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion (“screw toggling”) within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles.
Results
The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles,
p
= 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws,
p
= 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure.
Conclusions
Using nonme |
| doi_str_mv | 10.1007/s00586-018-5538-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2010373519</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2009417446</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-56d1cd228681e1f30bd8791ee874b5403d43bc4b9ff88ed72e295d4be2b1d4443</originalsourceid><addsrcrecordid>eNp1kF1rFTEQhoNU7LH6A7yRQG-8ic7kYze5lHL8wIIF9Tpsktnjlj2bmnSR_ntTtioIXs3FPO87w8PYC4TXCNC_qQDGdgLQCmOUFfYR26FWUoBT8oTtwGkQXY_ulD2t9RoAjYPuCTuVTrveGrljX64oTXEmXmOhn3xY4vdchgPxPPI4lJAXPk6Biig0LWMukRK_2u8_bXzl65Ko8HgX5ynyOQ9pWg7P2ONxmCs9f5hn7Nu7_deLD-Ly8_uPF28vRdRoboXpEsYkpe0sEo4KQrK9QyLb62A0qKRViDq4cbSWUi9JOpN0IBkwaa3VGXu19d6U_GOleuuPU400z8NCea1eAoLqlUHX0PN_0Ou8lqV916imCXutu0bhRsWSay00-psyHYdy5xH8vXG_GffNuL837m3LvHxoXsOR0p_Eb8UNkBtQ22o5UPl7-v-tvwDu34pl</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2009417446</pqid></control><display><type>article</type><title>Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Lindtner, Richard A. ; Schmid, Rene ; Nydegger, Thomas ; Konschake, Marko ; Schmoelz, Werner</creator><creatorcontrib>Lindtner, Richard A. ; Schmid, Rene ; Nydegger, Thomas ; Konschake, Marko ; Schmoelz, Werner</creatorcontrib><description>Purpose
Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws.
Methods
In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm
3
± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm
3
± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from − 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion (“screw toggling”) within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles.
Results
The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles,
p
= 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws,
p
= 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure.
Conclusions
Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-018-5538-8</identifier><identifier>PMID: 29497852</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Biomechanical Phenomena ; Bone cancer ; Bone Cements - analysis ; Bone mineral density ; Cadaver ; Cadavers ; Carbon Fiber - analysis ; Carbon fiber reinforcement ; Cement ; Female ; Fluoroscopy ; Fluoroscopy - methods ; Humans ; Ketones - analysis ; Load ; Lumbar Vertebrae - surgery ; Male ; Materials Testing - methods ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurosurgery ; Original Article ; Osteoporosis ; Pedicle Screws - adverse effects ; Pedicle Screws - statistics & numerical data ; Polyethylene Glycols - analysis ; Polymethylmethacrylate ; Prosthesis Design - adverse effects ; Prosthesis Design - methods ; Prosthesis Failure - etiology ; Radiation therapy ; Random Allocation ; Spinal cancer ; Spine ; Surgical Orthopedics ; Titanium ; Vertebrae ; Weight-Bearing</subject><ispartof>European spine journal, 2018-08, Vol.27 (8), p.1775-1784</ispartof><rights>The Author(s) 2018</rights><rights>European Spine Journal is a copyright of Springer, (2018). All Rights Reserved. © 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-56d1cd228681e1f30bd8791ee874b5403d43bc4b9ff88ed72e295d4be2b1d4443</citedby><cites>FETCH-LOGICAL-c415t-56d1cd228681e1f30bd8791ee874b5403d43bc4b9ff88ed72e295d4be2b1d4443</cites><orcidid>0000-0003-2962-2594</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-018-5538-8$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-018-5538-8$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29497852$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindtner, Richard A.</creatorcontrib><creatorcontrib>Schmid, Rene</creatorcontrib><creatorcontrib>Nydegger, Thomas</creatorcontrib><creatorcontrib>Konschake, Marko</creatorcontrib><creatorcontrib>Schmoelz, Werner</creatorcontrib><title>Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws.
Methods
In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm
3
± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm
3
± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from − 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion (“screw toggling”) within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles.
Results
The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles,
p
= 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws,
p
= 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure.
Conclusions
Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomechanical Phenomena</subject><subject>Bone cancer</subject><subject>Bone Cements - analysis</subject><subject>Bone mineral density</subject><subject>Cadaver</subject><subject>Cadavers</subject><subject>Carbon Fiber - analysis</subject><subject>Carbon fiber reinforcement</subject><subject>Cement</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Fluoroscopy - methods</subject><subject>Humans</subject><subject>Ketones - analysis</subject><subject>Load</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Materials Testing - methods</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Osteoporosis</subject><subject>Pedicle Screws - adverse effects</subject><subject>Pedicle Screws - statistics & numerical data</subject><subject>Polyethylene Glycols - analysis</subject><subject>Polymethylmethacrylate</subject><subject>Prosthesis Design - adverse effects</subject><subject>Prosthesis Design - methods</subject><subject>Prosthesis Failure - etiology</subject><subject>Radiation therapy</subject><subject>Random Allocation</subject><subject>Spinal cancer</subject><subject>Spine</subject><subject>Surgical Orthopedics</subject><subject>Titanium</subject><subject>Vertebrae</subject><subject>Weight-Bearing</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kF1rFTEQhoNU7LH6A7yRQG-8ic7kYze5lHL8wIIF9Tpsktnjlj2bmnSR_ntTtioIXs3FPO87w8PYC4TXCNC_qQDGdgLQCmOUFfYR26FWUoBT8oTtwGkQXY_ulD2t9RoAjYPuCTuVTrveGrljX64oTXEmXmOhn3xY4vdchgPxPPI4lJAXPk6Biig0LWMukRK_2u8_bXzl65Ko8HgX5ynyOQ9pWg7P2ONxmCs9f5hn7Nu7_deLD-Ly8_uPF28vRdRoboXpEsYkpe0sEo4KQrK9QyLb62A0qKRViDq4cbSWUi9JOpN0IBkwaa3VGXu19d6U_GOleuuPU400z8NCea1eAoLqlUHX0PN_0Ou8lqV916imCXutu0bhRsWSay00-psyHYdy5xH8vXG_GffNuL837m3LvHxoXsOR0p_Eb8UNkBtQ22o5UPl7-v-tvwDu34pl</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Lindtner, Richard A.</creator><creator>Schmid, Rene</creator><creator>Nydegger, Thomas</creator><creator>Konschake, Marko</creator><creator>Schmoelz, Werner</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2962-2594</orcidid></search><sort><creationdate>20180801</creationdate><title>Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading</title><author>Lindtner, Richard A. ; Schmid, Rene ; Nydegger, Thomas ; Konschake, Marko ; Schmoelz, Werner</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-56d1cd228681e1f30bd8791ee874b5403d43bc4b9ff88ed72e295d4be2b1d4443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomechanical Phenomena</topic><topic>Bone cancer</topic><topic>Bone Cements - analysis</topic><topic>Bone mineral density</topic><topic>Cadaver</topic><topic>Cadavers</topic><topic>Carbon Fiber - analysis</topic><topic>Carbon fiber reinforcement</topic><topic>Cement</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Fluoroscopy - methods</topic><topic>Humans</topic><topic>Ketones - analysis</topic><topic>Load</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Materials Testing - methods</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Osteoporosis</topic><topic>Pedicle Screws - adverse effects</topic><topic>Pedicle Screws - statistics & numerical data</topic><topic>Polyethylene Glycols - analysis</topic><topic>Polymethylmethacrylate</topic><topic>Prosthesis Design - adverse effects</topic><topic>Prosthesis Design - methods</topic><topic>Prosthesis Failure - etiology</topic><topic>Radiation therapy</topic><topic>Random Allocation</topic><topic>Spinal cancer</topic><topic>Spine</topic><topic>Surgical Orthopedics</topic><topic>Titanium</topic><topic>Vertebrae</topic><topic>Weight-Bearing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lindtner, Richard A.</creatorcontrib><creatorcontrib>Schmid, Rene</creatorcontrib><creatorcontrib>Nydegger, Thomas</creatorcontrib><creatorcontrib>Konschake, Marko</creatorcontrib><creatorcontrib>Schmoelz, Werner</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lindtner, Richard A.</au><au>Schmid, Rene</au><au>Nydegger, Thomas</au><au>Konschake, Marko</au><au>Schmoelz, Werner</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>27</volume><issue>8</issue><spage>1775</spage><epage>1784</epage><pages>1775-1784</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws.
Methods
In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm
3
± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm
3
± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from − 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion (“screw toggling”) within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles.
Results
The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles,
p
= 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws,
p
= 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure.
Conclusions
Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29497852</pmid><doi>10.1007/s00586-018-5538-8</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2962-2594</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2018-08, Vol.27 (8), p.1775-1784 |
| issn | 0940-6719 1432-0932 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2010373519 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Aged, 80 and over Biomechanical Phenomena Bone cancer Bone Cements - analysis Bone mineral density Cadaver Cadavers Carbon Fiber - analysis Carbon fiber reinforcement Cement Female Fluoroscopy Fluoroscopy - methods Humans Ketones - analysis Load Lumbar Vertebrae - surgery Male Materials Testing - methods Medicine Medicine & Public Health Middle Aged Neurosurgery Original Article Osteoporosis Pedicle Screws - adverse effects Pedicle Screws - statistics & numerical data Polyethylene Glycols - analysis Polymethylmethacrylate Prosthesis Design - adverse effects Prosthesis Design - methods Prosthesis Failure - etiology Radiation therapy Random Allocation Spinal cancer Spine Surgical Orthopedics Titanium Vertebrae Weight-Bearing |
| title | Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading |
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