Revision of failed pedicle screws using hydroxyapatite cement. A biomechanical analysis.
METHODS
The biomechanical influence of in situ setting hydroxyapatite cement was examined for use in pedicle screw revision surgery. Pull-out testing of control and pedicle screws augmented with hydroxyapatite cement was performed in human cadaver vertebrae.


OBJECTIVE
To determine the immediate effect of using hydroxyapatite cement to augment revision pedicle screws after failure of the primary pedicle screw fixation.


BACKGROUND
The potential problems associated with using polymethylmethacrylate to augment revision pedicular instrumentation have prompted the search for other solutions. The introduction of resorbable hydroxyapatite pastes may have provided new biocompatible solutions for pedicle screw revision.


METHODS
Ten human cadaver vertebrae were instrumented with 6.0-mm pedicle screws in each pedicle. The screws were loaded to failure in axial tension (pull-out). The failed pedicles then were instrumented with 7.0-mm pedicle screws, either augmented with hydroxyapatite cement or nonaugmented, which also were loaded to failure. Finally, the nonaugmented 7.0-mm screw hole was reinstrumented with a hydroxyapatite cement-augmented, 7.0-mm pedicle screw and loaded to failure.


RESULTS
The pull-out strength of the 7.0-mm, hydroxyapatite cement-augmented screws was 325% (P = 2.9 x 10(-5)) of that of the 6.0-mm control screws, whereas the strength of the 7.0-mm nonaugmented screws was only 73% (P = 2.0 x 10(-2)) of that of the 6.0-mm control screws. The 7.0-mm screws augmented with hydroxyapatite cement also were able to salvage 7.0-mm pull-out sites to 384% (P = 6.9E-5) of the pull-out strength of the 7.0-mm nonaugmented screws.


CONCLUSIONS
Hydroxyapatite cement may be a mechanically viable alternative to polymethyl methacrylate for augmenting revision pedicular instrumentation and should be considered for future experimental, animal, and clinical testing.
Veterans Affairs Rehabilitation and Research Design Center, Palo Alto, California, USA.
S A
SA
Yerby
E
E
Toh
R F
RF
McLain
D001696:Biomechanical Phenomena; D001843:Bone Cements; D001863:Bone Screws; D002102:Cadaver; D017886:Durapatite; D004868:Equipment Failure; D006801:Humans; D006882:Hydroxyapatites; D008159:Lumbar Vertebrae / Q000601:surgery; D008422:Materials Testing; D013123:Spinal Fusion / Q000295:instrumentation*
D001843:Bone Cements; D006882:Hydroxyapatites; C475044:hydroxyapatite cement; D017886:Durapatite