title: The Pullout Strength of Pedicle Screws Following Redirection After Lateral Wall Breach or End-plate Breach.
abstract: METHODS
  Using fresh cadavers, the biomechanical testing were used to examine the pullout strength of each pedicle screw.
  
  
  OBJECTIVE
  The aim of this study was to evaluate pullout strength of (1) a redirected pedicle screw following lateral wall breach; (2) a redirected pedicle screw following end-plate breach; and (3) a pedicle without redirection after end-plate breach without redirection.
  
  
  BACKGROUND
  Screw malposition, such as lateral wall breach or end-plate breach, is one of the main pitfalls of inserting pedicle screws.
  
  
  METHODS
  From 17 fresh spines, 54 vertebrae were harvested. In each vertebra on one pedicle, the screw was inserted correctly down the axis of the pedicle, while on the other pedicle, the screw was inserted to breach the lateral wall or the end-plate. The 18 pedicle screws that breached the lateral wall were then removed and redirected along the correct axis of the pedicle. The 18 pedicle screws that breached the end-plate were removed and redirected along the correct axis of the pedicle. The 18 other pedicle screws that had breached the end-plate were not removed. The pullout force of pedicle screws was measured.
  
  
  RESULTS
  First, the mean pullout strength for the redirected screws following lateral wall breach was 24.0% less as compared with the correctly aligned screws. Second, the mean pullout strength for the redirected screws following end-plate breach was 23.3% less as compared with the correctly aligned screws. Third, the mean pullout strength for the pedicle screws end-plate breach was 7.6% less as compared with the correctly aligned screws.
  
  
  CONCLUSIONS
  The pullout strength of redirected pedicle screws after either a lateral pedicle breach or end-plate breach is significantly less than the pullout strength of correctly aligned screw. A pedicle screw that is not redirected after end-plate breach is weaker than a pedicle screw correctly aligned; however, the difference is not significant.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Goda
authors.affiliation: Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Higashino
authors.affiliation: Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Toki
authors.affiliation: Department of Orthopaedics.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.affiliation: Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Orthopaedics.
authors.forename: Mineko
authors.initials: M
authors.lastname: Fujimiya
authors.affiliation: Atlanta Veterans Affairs Medical Center and the Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Williams C
authors.initials: WC
authors.lastname: Hutton
authors.affiliation: Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukui
authors.affiliation: Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena / Q000502:physiology*; D001860:Bone Plates; D002102:Cadaver; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000502:physiology* / Q000601:surgery; D008297:Male; D008422:Materials Testing; D065289:Pedicle Screws; D019415:Torque