title: Increasing bending strength and pullout strength in conical pedicle screws: biomechanical tests and finite element analyses.
abstract: METHODS
  Comparative in vitro biomechanical study and finite element analysis.
  
  
  OBJECTIVE
  To investigate the bending strength and pullout strength of conical pedicle screws, as compared with conventional cylindrical screws.
  
  
  BACKGROUND
  Transpedicle screw fixation, the gold standard of spinal fixation, is threatened by screw failure. Conical screws can resist screw breakage and loosening. However, biomechanical studies of bending strength have been lacking, and the results of pullout studies have varied widely.
  
  
  METHODS
  Ten types of pedicle screws with different patterns of core tapering and core diameter were specially manufactured with good control of all other design factors. The stiffness, yielding strength, and fatigue life of the pedicle screws were assessed by cantilever bending tests using high-molecular-weight polyethylene. The pullout strength was assessed by pullout tests using polyurethane foam. Concurrently, 3-dimensional finite element models simulating these mechanical tests were created, and the results were correlated to those of the mechanical tests.
  
  
  RESULTS
  In bending tests, conical screws had substantially higher stiffness, yielding strength, and fatigue life than cylindrical screws (P<0.01), especially when there was no step at the thread-shank junction. In pullout tests, pullout strength was higher in screws with a conical core and smaller core diameter and also in situations with higher foam density (P<0.01). In finite element analysis, the maximal deflection and maximal tensile stress were closely related to yielding strength (r=-0.91) and fatigue life (r=-0.95), respectively, in the bending analyses. The total reaction force was closely related to the pullout strength in pullout analyses (r=0.84 and 0.91 for different foam densities).
  
  
  CONCLUSIONS
  Conical screws effectively increased the bending strength and pullout strength simultaneously. The finite element analyses reliably predicted the results of the mechanical tests.
authors.affiliation: Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
authors.forename: Ching-Kong
authors.initials: CK
authors.lastname: Chao
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Hsu
authors.forename: Jaw-Lin
authors.initials: JL
authors.lastname: Wang
authors.forename: Jinn
authors.initials: J
authors.lastname: Lin
mesh_terms: D001863:Bone Screws; D019544:Equipment Failure Analysis; D020342:Finite Element Analysis; D006801:Humans; D008422:Materials Testing; D011474:Prosthesis Design; D013123:Spinal Fusion / Q000295:instrumentation*; D016474:Weight-Bearing