title: The effect on the pullout strength by the timing of pedicle screw insertion after calcium phosphate cement injection.
abstract: METHODS
  Biomechanical Cadaveric Study.
  
  
  OBJECTIVE
  To characterize the pullout strength of calcium phosphate cement augmented screws between 0 and 6 minutes after cement injection.
  
  
  BACKGROUND
  Earlier studies with calcium phosphate cement on pedicle screws inserted into a metal mold or sawbone have shown that the augmentation strength can be affected by the time between cement injection and screw insertion. However, these studies only compared soft cement to completely hardened cement with extended waiting times. These extended waiting times are impractical in live spinal surgeries.
  
  
  METHODS
  Twenty-four pedicle screws were inserted and pulled out axially from cadaveric bone to make revision models. The 24 screw holes were randomly divided into 4 groups, with each group having 6 holes. For each group, identical pedicle screws were inserted at 0, 2, 4, and 6 minutes after injection with bioresorbable calcium phosphate cement (CPC). After 24 hours, the augmented screws were pulled out axially and their pullout strengths were compared.
  
  
  RESULTS
  The difference between secondary pullout strength and primary pullout strength increased up to 4 minutes after cement injection but decreased after 6 minutes but without statistical difference among the 4 time settings (P>0.3).
  
  
  CONCLUSIONS
  The augmented screws had similar fixation strength regardless of the time between cement mixture and screw insertion as long as they are inserted within 6 minutes. Augmentation power tends to increase up to 4 minutes after cement injection but decreases after 6 minutes.
authors: Foundation for the Advancement of Spine Knowledge, Twin Cites Spine Center, 913 E. 26th Street, Minneapolis, MN 55404, USA. woojinchomd@aol.com
authors: Woojin
authors: W
authors: Cho
authors: Chunhui
authors: C
authors: Wu
authors: Serkan
authors: S
authors: Erkan
authors: Matthew M
authors: MM
authors: Kang
authors: Amir A
authors: AA
authors: Mehbod
authors: Ensor E
authors: EE
authors: Transfeldt
mesh_terms: D001843:Bone Cements; D001863:Bone Screws; D002130:Calcium Phosphates; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008422:Materials Testing; D013131:Spine / Q000601:surgery*
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate