title: Insertion torque and pullout force of rescue screws for anterior cervical plate fixation in a fatigued initial pilot hole.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether thicker-core-diameter screws increase fixation strength in the cervical spine.
  
  
  METHODS
  Bone mineral density (BMD) was determined for each vertebral body (VB) obtained in six human C4-7 segments. Based on their BMD, the specimens were assigned to one of two groups in which torque and pullout force were tested. Two initial pilot holes were drilled into the VBs and tests were first performed using a standard screw. The test was repeated using a thicker rescue screw inserted into the same initial pilot hole. The mean value of peak torque and pullout force resulting from the single left/right measurements was used for statistical analysis. A t-test was performed to determine the effect of screw design on peak torque and pullout force. Moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force. Mean insertional peak torque for the standard screw was 82.1 N/cm and that for the rescue screw was 47.6 Ncm (p < 0.001). There was a strong correlation between insertional peak torque and BMD for both standard screws (r = 0.71, p = 0.02) and rescue screws (r = 0.59, p = 0.07). The mean pullout force for standard screws was 464.7 N, whereas it was 164.5 N for rescue screws (p < 0.001). There was a strong correlation between pullout force and BMD for both standard (r = 0.75, p = 0.0081) and rescue screws (r = 0.7, p = 0.025).
  
  
  CONCLUSIONS
  Uncemented rescue screws that have been inserted into a fatigued hole in the cervical VB do not strengthen the screw-bone interface compared with the strength initially conferred by a standard screw.
authors.affiliation: Neurosurgical Department, University of Saarland, Homburg, Germany. pitzen@t-online.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Pitzen
authors.forename: Frederick
authors.initials: F
authors.lastname: Franta
authors.forename: Dragos
authors.initials: D
authors.lastname: Barbier
authors.forename: Wolf-Ingo
authors.initials: WI
authors.lastname: Steudel
mesh_terms: D000368:Aged; D015519:Bone Density; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D002574:Cervical Vertebrae / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D008422:Materials Testing; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D013314:Stress, Mechanical; D013499:Surface Properties; D019415:Torque