title: Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine.
abstract: BACKGROUND
  Pedicle screws have been shown to be superior to hooks in the lumbar spine, but few studies have addressed their use in the thoracic spine.
  
  
  OBJECTIVE
  The objective of this study was to biomechanically evaluate the pullout strength of pedicle screws in the thoracic spine and compare them to laminar hooks. STUDY DESING/SETTING: Twelve vertebrae (T1-T12) were harvested from each of five embalmed human cadavers (n=60). The age of the donors averaged 83+8.5 years. After bone mineral density had been measured in the vertebrae (mean=0.47 g/cm(3)), spines were disarticulated. Some pedicles were damaged during disarticulation or preparation for testing, so that 100 out of a possible 120 pullout tests were performed.
  
  
  METHODS
  Each vertebra was secured using a custom-made jig, and a posteriorly directed force was applied to either the screw or the claw. Constructs were ramped to failure at 3 mm/min using a Mini Bionix II materials testing machine (MTS, Eden Prairie, MN).
  
  
  RESULTS
  Pedicle claws had an average pullout strength of 577 N, whereas the pullout strength of pedicle screws averaged 309 N. Hooks installed using the claw method in the thoracic spine had an overwhelming advantage in pullout strength versus pedicle screws. Even in extremely osteoporotic bone, the claw withstood 88% greater pullout load.
  
  
  CONCLUSIONS
  The results of this study indicate that hooks should be considered when supplemental instrumentation is required in thoracic vertebrae, especially in osteoporotic bone.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, 1600 SW Archer Road, Gainesville, 32610, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cordista
authors.forename: Bryan
authors.initials: B
authors.lastname: Conrad
authors.forename: MaryBeth
authors.initials: M
authors.lastname: Horodyski
authors.forename: Sheri
authors.initials: S
authors.lastname: Walters
authors.forename: Glenn
authors.initials: G
authors.lastname: Rechtine
mesh_terms: D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D004867:Equipment Design; D006801:Humans; D008422:Materials Testing; D013314:Stress, Mechanical; D013524:Surgical Flaps; D013904:Thoracic Vertebrae / Q000601:surgery*