title: A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation.
abstract: OBJECTIVE
  Instrumentation of the osteoporotic spine can be fraught with complications such as hardware failure. A cadaver study was performed to determine the biomechanical performance of polymethylmethacrylate (PMMA)-augmented pedicle screws.
  
  
  METHODS
  Three osteoporotic human cadaveric specimens with a mean bone mineral density of 0.70 g/cm2 were used to evaluate the performance of a novel fenestrated bone tap in pedicle screw augmentation. On this device, tap threads serve a dual purpose in preventing backflow of cement toward neural elements while allowing for a custom form for subsequent screw placement. The tap was used to inject a mean volume of 3.7 ml PMMA/pedicle (range 2-8.0 ml PMMA/pedicle) followed by pedicle screw placement between L-5 and T-5, alternating between augmented and nonaugmented instrumentation. Axial pullout testing was then performed.
  
  
  RESULTS
  Pedicle screw pullout strength was increased in both primary and salvage procedures by 119% (p = 0.001) and 162% (p = 0.01), respectively, after PMMA augmentation. Additionally, the injected cement volumes were divided into two groups, a low-cement group (< or = 2.8 ml/pedicle) and a high-cement group (> or = 5.5 ml/pedicle). Interestingly, the pullout strength did not significantly change with increased cement usage between the two groups (p > 0.05 for all comparisons).
  
  
  CONCLUSIONS
  Polymethylmethacrylate-augmented pedicle screw fixation results in a significant increase in the axial pullout strength of augmented pedicle screws in both primary and revision procedures. This technique may be a valuable adjunct in cases in which bolstering of the screw-bone interface is necessary.
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. frankel@musc.edu
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Frankel
authors.forename: Sabino
authors.initials: S
authors.lastname: D'Agostino
authors.forename: Chiang
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D001863:Bone Screws; D002102:Cadaver; D004867:Equipment Design; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D011859:Radiography; D012086:Reoperation; D013718:Tensile Strength; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate