title: Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques.
abstract: METHODS
  In vitro biomechanical comparison of two methods of pedicle screw placement in cadaveric thoracic spine vertebrae.
  
  
  OBJECTIVE
  Compare the biomechanical integrity of extrapedicular and transpedicular screw fixation under axial and sagittal pullout loads.
  
  
  BACKGROUND
  Extrapedicular screw placement has been advocated as a safe and effective alternative to the transpedicular screw in thoracic vertebrae. Rigorous biomechanical comparison of these two techniques is presently lacking in the literature.
  
  
  METHODS
  Thirty-seven vertebral bodies were dissected from six cadaveric thoracic spines. Each body had two polyaxial 5.0-mm screws placed: one transpedicular and one extrapedicular. The 62 screws were randomly designated for one of two loading methods: axial or sagittal. Failure load (N), taken as maximum force on the load-deformation curve, and stiffness (N/mm), calculated between 50 N and 400 N, were measured. RESULTS.: Transpedicular screws were statistically stronger in both testing methods (P = 0.008). Load direction, whether axial or sagittal, had no bearing on pullout strength (P = 0.6).
  
  
  CONCLUSIONS
  These data indicate that transpedicular screws are biomechanically superior to extrapedicular screws. This difference is small, however, and we think that extrapedicular screws offer an excellent alternative when anatomy dictates their use with other screws in segmental spinal constructs.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.
authors.forename: Klane K
authors.initials: KK
authors.lastname: White
authors.forename: Richard
authors.initials: R
authors.lastname: Oka
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Mahar
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lowry
authors.forename: Steven R
authors.initials: SR
authors.lastname: Garfin
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D013718:Tensile Strength; D013904:Thoracic Vertebrae / Q000601:surgery*