Biomechanical Study of 3 Osteoconductive Materials Applied in Pedicle Augmentation and Revision for Osteoporotic Vertebrae: Allograft Bone Particles, Calcium Phosphate Cement, Demineralized Bone Matrix

Neurospine, 2023 · DOI: https://doi.org/10.14245/ns.2346760.380 · Published: December 1, 2023

Surgery Biomechanics Musculoskeletal Medicine

Simple Explanation

This study explores methods to improve the stability of screws used in spinal surgeries, particularly in patients with osteoporosis. Screw loosening is a common problem, leading to complications. The research compares three materials—allograft bone particles (ABP), calcium phosphate cement (CPC), and demineralized bone matrix (DBM)—to see how well they enhance screw stability when used for augmentation (strengthening existing screws) and revision (replacing loosened screws). The study found that all three materials improved screw stability to some extent. CPC was the most effective, followed by ABP. DBM was the least effective. For replacing loosened screws, CPC is recommended, with ABP as a possible alternative, while DBM is not recommended.

Study Duration

Not specified

Participants

120 human cadaveric vertebrae

Evidence Level

Not specified

Key Findings

1
ABP, CPC, and DBM significantly enhanced biomechanical properties of the screws.
2
CPC augmentation showed superior properties compared to ABP or DBM.
3
CPC-revised screws exhibited similar strength to the original screws, while ABP-revised screws showed comparable cycles to failure and failure loads but lower pullout strength.

Research Summary

This study evaluated the biomechanical properties of pedicle screws augmented or revised with allograft bone particles (ABP), calcium phosphate cement (CPC), and demineralized bone matrix (DBM) in osteoporotic vertebrae. The results showed that ABP, CPC, and DBM effectively improve pedicle screw stability for augmentation, with CPC demonstrating the highest efficacy, followed by ABP, and then DBM. For pedicle revision, CPC is recommended as the primary choice, while DBM is not recommended.

Practical Implications

Surgical Material Selection

Provides surgeons with a comparative analysis of different materials for pedicle screw augmentation and revision in osteoporotic patients, aiding in material selection.

Revision Surgery Guidance

Offers recommendations against using DBM for pedicle screw revision due to its inferior biomechanical performance compared to CPC and ABP.

Future Research

Highlights the need for further in vivo studies to validate the long-term biological effects and grip strength changes of these materials after implantation.

Study Limitations

1
Small sample size of vertebral bones due to limited availability of cadavers.
2
The cadaveric biomechanical testing may not fully replicate the actual stress conditions experienced by pedicle screws in vivo.
3
Further research is necessary to explore the in vivo transformation of these materials.

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