title: Design and biomechanical study of a modified pedicle screw.
abstract: OBJECTIVE
  In pedicle screw fixation, the heads of monoaxial screws need to be directed in the same straight line to accommodate the rod placement by backing out during operation, which decreases the insertional torque and internal fixation strength. While polyaxial screws facilitate the assembly of the connecting rod, but its ball-in-cup locking mechanism reduces the static compressive bending yield strength as compared with monoaxial screws. Our study aimed to assess the mechanical performance of a modified pedicle screw.
  
  
  METHODS
  In this study, the tail of the screw body of the modified pedicle screw was designed to be a cylinder-shaped structure that well matched the inner wall of the screw head and the screw head only rotated around the cyclinder. Monoaxial screws, modified screws and polyaxial screws were respectively assembled into 3 groups of vertebrectomy models simulated by ultra high molecular weight polyethylene (UHMWPE) blocks. This model was developed according to a standard for destructive mechanical testing published by the American Society for Testing Materials (ASTM F1717-04). Each screw design had 6 subgroups, including 3 for static tension, load compression and torsion tests, and the rest for dynamic compression tests. In dynamic tests, the cyclic loads were 25%, 50%, and 75% of the compressive bending ultimate loads respectively. Yield load, yield ultimate load, yield stiffness, torsional stiffness, cycles to failure and modes of failure for the 3 types of screws were recorded. The results of modified screws were compared with those of monoaxial and polyaxial screws.
  
  
  RESULTS
  In static tests, results of bending stiffness, yield load, yield torque and torsional stiffness indicated no significant differences between the modified and monoaxial screws (P > 0.05), but both differed significantly from those of polyaxial screws (P < 0.05). In dynamic compression tests, both modified and monoaxial screws showed failures that occurred at the insertion point of screw body into the UHMWPE block, while the polyaxial screw group showed screw body swung up and down the screw head because of loosening of the ball-in-cup mechanism.
  
  
  CONCLUSIONS
  The modified screw is well-designed and biomechanically improved. And it can provide sufficient stability for segment fixation as monoaxial screws.
authors.affiliation: Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Wen-jie
authors.initials: WJ
authors.lastname: Zheng
authors.forename: Chang-qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Liu
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D001863:Bone Screws; D019245:Compressive Strength; D004867:Equipment Design; D006801:Humans; D066298:In Vitro Techniques; D016268:Internal Fixators; D008422:Materials Testing; D008961:Models, Structural; D013131:Spine / Q000601:surgery*; D013718:Tensile Strength; D054159:Torsion, Mechanical