title: Cortex of the pedicle of the vertebral arch. Part I: Deformation characteristics during screw insertion.
abstract: OBJECTIVE
  Elastic deformation has been proposed as a mechanism by which vertebral pedicles can maintain pullout strength when conical screws are backed out from full insertion. The response to the insertion technique may influence both the extent of deformation and the risk of acute fracture during screw placement. The aim of this study was to determine the deformation characteristics of the lumbar pedicle cortex during screw placement.
  
  
  METHODS
  Lumbar pedicles with linear strain gauges attached at the lateral and medial cortices were instrumented using 7.5-mm pedicle screws with or without preconditioning by insertion and removal of 6.5-mm screws. The strains and elastic recoveries of the medial and lateral cortices were determined.
  
  
  RESULTS
  Mean medial wall strains tended to be lower than mean lateral wall strains when the 6.5-mm and 7.5-mm screw data were pooled (p = 0.07). After the screws had been removed, 71 to 79% of the deformation at the lateral cortex and 70 to 96% of the deformation at the medial cortex recovered. When inserted first, the 7.5-mm screw caused more plastic deformation at the cortex than it did when inserted after the 6.5-mm screw. Occasional idiosyncratic strain patterns were observed. No gross fracture was observed during screw placement.
  
  
  CONCLUSIONS
  Screw insertion generated plastic deformation at the pedicle cortex even though the screw did not directly contact the cortex. The lateral and medial cortices responded differently to screw insertion. The technique of screw insertion affected the deformation behavior of the lumbar pedicles. With myriad options for screw selection and placement available, further study is needed before optimal placement parameters can be verified.
authors: Spine Research Laboratory, The Cleveland Clinic Spine Institute, Ohio 44195, USA. inceogs@ccf.org
authors: Serkan
authors: S
authors: Inceoğlu
authors: Cumhur
authors: C
authors: Kilinçer
authors: Andrea
authors: A
authors: Tami
authors: Robert F
authors: RF
authors: McLain
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013314:Stress, Mechanical; D019415:Torque