title: Biomechanical comparison of alternative densities of pedicle screws for the treatment of adolescent idiopathic scoliosis.
abstract: OBJECTIVE
  The objective of this computational study was to compare the biomechanical effects of different implant densities in terms of curve reduction and the force levels at the implant-vertebra interface and on the intervertebral elements.
  
  
  METHODS
  Eight cases were randomly picked among patients who have undergone a posterior spinal instrumentation for adolescent idiopathic scoliosis (AIS). For each case, two computer simulations were performed, one with the actual surgery implant pattern and another with the same fusion levels but an alternative implant pattern proposed by an experienced surgeon. The two implant patterns for each case were respectively put into higher and lower implant density group. The spinal correction and the force levels at bone-implant interface and on the intervertebral elements were analyzed and compared between the two groups.
  
  
  RESULTS
  There were on average 13% more pedicle screws and 30% more bilaterally placed pedicle screws in the higher versus lower density group. The difference in the density of screws (92% vs. 79%) did not lead to significant difference in terms of the resulting main thoracic (MT) Cobb angle, and the MT apical axial vertebral rotation. The average and maximum implant-vertebra force levels were about 50 and 65%, respectively higher in the higher versus lower density group, but without consistent distribution patterns. The average intervertebral forces did not significantly differ between the two groups.
  
  
  CONCLUSIONS
  With the same fusion levels, lower density screws allowed achieving similar deformity correction and it was more likely to have lower screw-vertebra loads.
authors: Department of Mechanical Engineering, Ecole Polytechnique de Montréal, Downtown Station, Montreal, QC, Canada.
authors: Xiaoyu
authors: X
authors: Wang
authors: Carl-Eric
authors: CE
authors: Aubin
authors: Isabelle
authors: I
authors: Robitaille
authors: Hubert
authors: H
authors: Labelle
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena / Q000502:physiology; D001863:Bone Screws; D002648:Child; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*