title: Pullout performance comparison of novel expandable pedicle screw with expandable poly-ether-ether-ketone shells and cement-augmented pedicle screws.
abstract: Aim of this study is to assess the pullout performance of various pedicle screws in different test materials. Polyurethane foams (Grade 10 and Grade 40) produced in laboratory and bovine vertebrae were instrumented with normal, cannulated (cemented), novel expandable and normal (cemented) pedicle screws. Test samples were prepared according to the ASTM F543 standard testing protocols and surgical guidelines. To examine the screw placement and cement distribution, anteriosuperior and oblique radiographs were taken from each sample after insertion process was completed. Pullout tests were performed in an Instron 3369 testing device. Load versus displacement graphs were recorded and the ultimate pullout force was defined as the maximum load (pullout strength) sustained before failure of screw. Student's t-test was performed on each group whether the differences between pullout strength of pedicle screws were significant or not. While normal pedicle screws have the lowest pullout strength in all test materials, normal pedicle screws cemented with polymethylmethacrylate exhibit significantly higher pullout performance than others. For all test materials, there is a significant improvement in pullout strength of normal screws by augmentation. While novel expandable pedicle screws with expandable poly-ether-ether-ketone shells exhibited lower pullout performance than normal screws cemented with polymethylmethacrylate, their pullout performances in all groups were higher than the ones of normal and cannulated pedicle screws. For all test materials, although cannulated pedicle screws exhibit higher pullout strength than normal pedicle screws, there are no significant differences between the two groups. The novel expandable pedicle screws with expandable poly-ether-ether-ketone shells may be used instead of normal and cannulated pedicle screws cemented with polymethylmethacrylate due to their good performances.
authors.affiliation: 1 Department of Mechanical Engineering, Gazi University, Ankara, Turkey.
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Aycan
authors.affiliation: 2 Department of Orthopaedics, Ankara Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Tolunay
authors.affiliation: 3 Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey.
authors.forename: Teyfik
authors.initials: T
authors.lastname: Demir
authors.affiliation: 4 Department of Neurosurgery, Memorial Ankara Hospital, Ankara, Turkey.
authors.forename: Mesut Emre
authors.initials: ME
authors.lastname: Yaman
authors.affiliation: 1 Department of Mechanical Engineering, Gazi University, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Usta
mesh_terms: D000818:Animals; D001577:Benzophenones; D001696:Biomechanical Phenomena; D001843:Bone Cements; D002417:Cattle; D019544:Equipment Failure Analysis; D006801:Humans; D066298:In Vitro Techniques; D007659:Ketones; D008422:Materials Testing; D065289:Pedicle Screws; D011092:Polyethylene Glycols; D011108:Polymers; D011140:Polyurethanes; D013123:Spinal Fusion / Q000295:instrumentation
chemical_list: D001577:Benzophenones; D001843:Bone Cements; D007659:Ketones; D011108:Polymers; D011140:Polyurethanes; C063834:polyetheretherketone; D011092:Polyethylene Glycols; C028279:polyurethane foam
keywords: Bovine vertebra; expandable; pedicle screw; poly-ether-ether-ketone shell; polyurethane foam; pullout test