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张 学, 顾 祖, 张 宇, 李 果. [Comparison of Clinical Effects of Cortical Bone Trajectory Screws and Traditional Pedicle Screws in Posterior Lumbar Fusion]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:303-308. [PMID: 38645868 PMCID: PMC11026896 DOI: 10.12182/20240360205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Indexed: 04/23/2024]
Abstract
Objective To compare the clinical effects of cortical bone trajectory screws and traditional pedicle screws in posterior lumbar fusion. Methods A retrospective study was conducted to analyze lumbar degeneration patients who underwent surgical treatment at our hospital between January 2016 and January 2019. A total of 123 patients who met the inclusion criteria were enrolled. The subjects were divided into two groups according to their surgical procedures and the members of the two groups were matched by age, sex, and the number of fusion segments. There were 63 patients in the traditional pedicle screws (PS) group and 60 in the cortical bone trajectory screws (CBTS) group. The outcomes of the two groups were compared. The primary outcome measures were perioperative conditions, including operation duration, estimated intraoperative blood loss (EBL), and length-of-stay (LOS), visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and interbody fusion rate. The secondary outcome measures were the time to postoperative ambulation and the incidence of complications. VAS scores and ODI scores were assessed before operation, 1 week, 1 month, 3 months, and 12 months after operation, and at the final follow-up. The interbody fusion rate was assessed in 1 year and 2 years after the operation and at the final follow-up. Results The CBTS group showed a reduction in operation duration ([142.8±13.1] min vs. [174.7±15.4] min, P<0.001), LOS ([9.5±1.5] d vs. [12.0±2.0] d, P<0.001), and EBL ([194.2±38.3] mL vs. [377.5±33.1] mL, P<0.001) in comparison with the PS group. The VAS score for back pain in the CBTS group was lower than that in the PS group at 1 week and 1 month after operation and the ODI score in the CBTS group was lower than that in the PS group at 1 month after operation, with the differences being statistically significant (P<0.05). At each postoperative time point, the VAS score for leg pain and the interbody fusion rate did not show significant difference between the two groups. The VAS score for back and leg pain and the ODI score at each time point after operation in both the CBTS group and the PS group were significantly lower than those before operation (P<0.05). No significant difference was found in the time to postoperative ambulation or the overall complication incidence between the two groups. Conclusion The CBTS technique could significantly shorten the operation duration and LOS, reduce EBL, and achieve the same effect as the PS technique does in terms of intervertebral fusion rate, pain relief, functional improvement, and complication incidence in patients undergoing posterior lumbar fusion.
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Affiliation(s)
- 学磊 张
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 祖超 顾
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 宇 张
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 果 李
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
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Song T, Sun F, Liu S, Ye T. Percutaneous lordoplasty for the treatment of severe osteoporotic vertebral compression fractures with kyphosis. Front Neurol 2023; 14:1132919. [PMID: 37576011 PMCID: PMC10416795 DOI: 10.3389/fneur.2023.1132919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The study aimed to explore the safety and effectiveness of percutaneous lordoplasty (PLP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods Included in this prospective study were patients with single-segment acute severe OVCF who were treated with PLP in our institution from July 2016 to October 2019. Patients' back pain and quality of life were assessed using the visual analog scale (VAS) and SF-36 scores. Lateral X-ray radiography of the spine was performed to measure the vertebral height, vertebral kyphotic angle, and segmental kyphotic angle, and to evaluate the outcome of fracture reduction and kyphotic correction. Intra-and postoperative complications were recorded. Results Of the 51 included patients, 47 patients were followed up for 12 months. The VAS score decreased from preoperative 7.33 ± 1.92 to postoperative 1.76 ± 0.85 at the 12th month (p < 0.05), and the SF-36 score increased from preoperative 79.50 ± 9.22 to postoperative 136.94 ± 6.39 at the 12th month (p < 0.05). During the 1-year follow-up period, the anterior height of the vertebral body increased significantly from preoperative 10.49 ± 1.93 mm to 19.33 ± 1.86 mm (p < 0.05); the posterior height of the vertebral body increased insignificantly from preoperative 22.23 ± 2.36 mm to 23.05 ± 1.86 mm (p > 0.05); the vertebral kyphotic angle decreased significantly from preoperative 18.33° ± 11.49° to 8.73° ± 1.21° (p < 0.05); and the segmental kyphotic angle decreased significantly from preoperative 24.48° ± 4.64° to 11.70° ± 1.34° (p < 0.05). During the 1-year follow-up period, there was no significant difference in the radiologic parameters, VAS scores, and SF-36 scores, between the 1st day and the 12th month of post-operation (P > 0.05). No nerve damage occurred in any of the cases. Intraoperative cement leakage occurred in six cases, and the fracture of the adjacent vertebral body occurred in one case. Conclusion PLP can well reduce the risk of fracture and achieve good kyphotic correction and may prove to be a safe, cost-effective and minimally invasive alternative option for the treatment of severe OVCF with kyphotic deformity.
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Affiliation(s)
- Tengfei Song
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Fan Sun
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopedics, The Fourth Affiliated Hospital of Nangjing Medical University, Nanjing, Jiangsu, China
| | - Shu Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tianwen Ye
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
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Wang Y, Feng T, Wang S, Fu H, Li C, Sun H. Midline Lumbar Fusion Versus Posterior Lumbar Interbody Fusion Involving L5-S1 For Degenerative Lumbar Diseases: A Comparative Study. World Neurosurg 2023; 172:e86-e93. [PMID: 36621668 DOI: 10.1016/j.wneu.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND A retrospective cohort study to evaluate the efficacy and safety of midline lumbar fusion (MIDLF) for lumbosacral fusion compared to posterior lumbar interbody fusion (PLIF). METHODS Patients who had undergone posterior lumbosacral fusion surgery were divided into a MIDLF group (n = 37) and a PLIF group (n = 42). The follow-up time was at least 12 months. The operation data, recovery condition, complications, clinical outcomes, and status of implants and fusion were compared between the 2 groups. RESULTS The MIDLF group experienced significantly less blood loss, lower postoperative creatine kinase levels and total drainage volume, earlier time to ambulation, and less hospital stay times after surgery compared to the PLIF group (P < 0.05). The mean postoperative back pain visual analog scale scores in the MIDLF group were significantly lower than the PLIF group (P < 0.05). The improvement in Oswestry Disability Index scores during 3-month follow-up displayed a significant difference between the 2 groups (P < 0.05). The fusion rate tended to be higher in the MIDLF group; however, the difference was not significant (P > 0.05). There was no significant difference in respect to screw loosening and cage subsidence rate. There were 2 cases of complications both occurring in the PLIF group. CONCLUSIONS MIDLF is safe and effective for lumbosacral fusion and in line with the concept of enhanced recovery after surgery.
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Affiliation(s)
- Yuetian Wang
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Tianhao Feng
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Shijun Wang
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Haoyong Fu
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Chunde Li
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Haolin Sun
- Department of Orthopedic, Peking University First Hospital, Beijing, China.
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Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2534350. [PMID: 36506913 PMCID: PMC9729043 DOI: 10.1155/2022/2534350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Multilevel lumbar fusion with posterior pedicle screw fixation is a widely performed surgical procedure for the management of adult spinal deformity. However, there has not been a comprehensive biomechanical study on the different types of fusion levels in terms of stability and possible complications. We aimed to investigate the biomechanical properties of multilevel lumbar fusion according to different types of upper and lower fusion levels. Six different types of fusions were performed using three-dimensional finite element models. Type A and B referred to the group of which upper fusion level was L1 and T10, respectively. Subtype 1, 2, and 3 referred to the group of which lower fusion level was L5, S1, and ilium, respectively (A1, L1-L5; A2, L1-S1; A3, L1-ilium; B1, T10-L5; B2, T10-S1; B3, T10-ilium). Flexion, extension, axial rotation, and lateral bending moments were applied, and the risk of screw loosening and failure and adjacent segment degeneration (ASD) was analyzed. Stress at the bone-screw interface of type B3 was lowest in overall motions. The risk of screw failure showed increasing pattern as the upper and lower levels extended in all motions. Proximal range of motion (ROM) increased as the lower fusion level changed from L5 to S1 and the ilium. For axial rotation, type B3 showed higher proximal ROM (16.2°) than type A3 (11.8°). In multilevel lumbar fusion surgery for adult spinal deformity, adding iliac screws and increasing the fusion level to T10-ilium may lower the risk of screw loosening. In terms of screw failure and proximal ASD, however, T10-ilium fusion has a higher potential risk compared with other fusion types. These results will contribute for surgeons to provide adequate patient education regarding screw failure and proximal ASD, when performing multilevel lumbar fusion.
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New approaches to proven technology: force control posterior thoracolumbar fusion with an innovative pedicle screw system. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Xiong Y, Li L, Liu P, Zhou B, Kang Y, Wang G. Effect of Teriparatide Versus Zoledronate on Posterior Lumbar Interbody Fusion in Postmenopausal Women with Osteoporosis. World Neurosurg 2022; 167:e1310-e1316. [PMID: 36096387 DOI: 10.1016/j.wneu.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the efficacy of teriparatide versus zoledronate on spinal fusion in osteoporotic patients after posterior lumbar interbody fusion (PLIF). METHODS Postmenopausal women with osteoporosis undergoing PLIF for degenerative spondylolisthesis were randomly assigned to receive either zoledronate or teriparatide. During the 2-year follow-up period, serial radiographs were used to determine fusion status and instrumentation-related sequelae (a composite of adjacent vertebral compressive fracture, instrumentation failure, and fusion failure). The bone mineral density (BMD) and Oswestry disability index (ODI) were also serially measured. RESULTS Of the 77 patients, 36 were in the teriparatide group and 41 in the zoledronate group and had completed the 2-year follow-up assessments. Bony union had been achieved more frequently in the teriparatide group than in the zoledronate group at 6 months postoperatively (P < 0.05), although the overall rate of bone union was comparable between the 2 groups. The incidence of instrumentation-related sequelae was also comparable between the 2 groups (teriparatide vs. zoledronate group, 13.9% vs. 22.0%). Regarding antiosteoporosis, the BMD values had significantly improved in both groups at the last follow-up. The teriparatide group had attained more BMD increments at 12 months postoperatively than had the zoledronate group. Furthermore, the ODI had consistently decreased in both groups with a lower ODI in the teriparatide group than in the zoledronate group at 12 months postoperatively. CONCLUSIONS Among postmenopausal women with osteoporosis, teriparatide showed superior bone union at 6 months and greater BMD improvement at 12 months after PLIF compared with zoledronate administration, although both resulted in similar overall effects on spinal fusion.
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Affiliation(s)
- Yu Xiong
- Department of Spine Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Liang Li
- Department of Spine Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Ping Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Bin Zhou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Yijun Kang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Guoqiang Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China.
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Zhang Y, Li Y, Hai Y, Guan L, Zhang X, Pan A, Lu H, Wu B, Liu Y. A nomogram for predicting screw loosening after single-level posterior lumbar interbody fusion utilizing cortical bone trajectory screw: A minimum 2-year follow-up study. Front Surg 2022; 9:950129. [PMID: 36311946 PMCID: PMC9615560 DOI: 10.3389/fsurg.2022.950129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose This study aims to investigate the risk factors for screw loosening after single-level posterior lumbar interbody fusion (PLIF) utilizing cortical bone trajectory (CBT) screw and establish a nomogram for predicting screw loosening. Methods A total of 79 patients (316 screws) who underwent single-level PLIF with CBT screw were included in the study. Preoperative, postoperative, and final follow-up demographic data, surgical data, and radiographic parameters were documented and analyzed to identify risk factors, and a predictive nomogram was established for screw loosening. The nomogram was assessed by concordance index (C-index), calibration plot, decision curve analysis (DCA), and internal validation. Results The incidence of screw loosening was 26.6% in 79 patients and 11.4% in 316 screws. Multifactorial regression analysis confirmed that fixed to S1 (FS1, OR = 3.82, 95% CI 1.12-12.71, P = 0.029), the coronal angle of the screw (CA, OR = 1.07, 95% CI 1.01-1.14, P = 0.039), and cortical bone contacted layers (CBCLs, OR = 0.17, 95% CI 0.10-0.29, P < 0.001) were risk factors and incorporated in the nomogram for predicting screw loosening after single-level PLIF with a CBT screw. The C-index of the nomogram was 0.877 (95% CI 0.818-0.936), which demonstrated good predictive accuracy. The calibration plot indicated an acceptable calibration of the nomogram that also had a positive benefit in guiding treatment decisions. Conclusion FS1, CA, and CBCLs are identified to be significant risk factors for screw loosening after single-level PLIF with the CBT technique. The nomogram we have established can be used to predict screw loosening and contribute to surgical decisions.
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Affiliation(s)
- Yiqi Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,Department of Orthopedics, The General Hospital of Taiyuan Iron / Steel (Group) Corporation, Taiyuan, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,Correspondence: Yuzeng Liu Yong Hai
| | - Li Guan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinuo Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aixing Pan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongyi Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bingchao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,Correspondence: Yuzeng Liu Yong Hai
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Han X, Chen X, Li K, Li Z, Li S. Bending rod is unnecessary in single-level posterior internal fixation and fusion in treatment of lumbar degenerative diseases. BMC Surg 2021; 21:394. [PMID: 34742264 PMCID: PMC8572457 DOI: 10.1186/s12893-021-01386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bending rod is a routine in lumbar fusion and fixation surgery, but there is no study investigating whether bending rod in one level is necessary. Methods Patients receiving 1 level lumbar fixation and fusion between May 2018 and September 2020 were included with a minimum 6-month follow-up. The routine of bending rod was omitted during fixation. Preoperative and postoperative radiological parameters were compared. Results There were 67 patients included in the study. Segment lordosis angle increased obviously from 10° (1–39°) to 14° (2–30°) immediately after operation (p = 0.000). T5-T12 increased from 22.97 ± 12.31° to 25.52 ± 11.83° by the 3rd months after surgery (p = 0.011). SS decreased from 35.45 ± 10.47 to 32.19 ± 11.37 in 6-month follow-up (p = 0.038), and PI dropped from 56.97 ± 14.24 to 53.19 ± 12.84 (p = 0.016). ROM of SLA decreased from 4.13 ± 3.14° to 1.93 ± 1.87° at that time point (p = 0.028). Those changes were not seen at 12-month follow-up. No evidence of adjacent vertebral disc degeneration was observed at any time point. Conclusions No sagittal imbalance, dynamic instability or adjacent vertebral degeneration was observed by the 12th month after single-segment posterior lumbar fusion with the use of unbent rods. Bending rod could be omitted in 1-level lumbar fusion to simplify the procedure and reduce operating time.
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Affiliation(s)
- Xiao Han
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Kuan Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China.
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Nakashima D, Mikami K, Kikuchi S, Nishikino M, Kitamura T, Hasegawa N, Matsumoto M, Nakamura M, Nagura T. Laser resonance frequency analysis of pedicle screw stability: A cadaveric model bone study. J Orthop Res 2021; 39:2474-2484. [PMID: 33458845 PMCID: PMC8596623 DOI: 10.1002/jor.24983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
There is no evaluation method currently available to assess intraoperative pedicle screw fixation (PSF) strength. In this study, we established a laser-based resonance frequency analysis (RFA) system with high-speed, noncontact, quantitative measurements of PSF. Clinical investigations in the future can assess surgical failure risk of implants. We investigated the characteristics of the laser RFA and compared them with the conventional methods. We inserted a pedicle screw in the vertebral pedicle of human cadaver or model bone, followed by screw pull-out, peak torque, implant stability quotient (ISQ) value obtained by the magnetic dental RFA system, and fixation force of laser RFA. We compared the outcomes using best-fit linear or logarithmic approximations. For the model bone study, the resonance frequency (RF) versus peak torque/pull-out force (POF) demonstrated strong correlations using logarithmic approximation (vs. peak torque: R = 0.931, p < .001, vs. POF: R = 0.931, p < .001). RF strongly correlated with the ISQ value using linear approximation (R = 0.981, p < .001). For the cadaveric vertebrae study, the correlation coefficients between RF and the peak torque/POF were significant regardless of approximation method (peak torque: logarithmic: R = 0.716 vs. linear: R = 0.811; p < .001) (POF: logarithmic: R = 0.644 vs. linear: R = 0.548; p < .05). Thus, the results of this study revealed a constant correlation between RFA and conventional methods as a measurement validation, predicting favorable support for intraoperative PSF. RFA has the potential to be a new index for evaluating the implant fixation force.
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Affiliation(s)
- Daisuke Nakashima
- Department of Orthopedic SurgeryKeio University School of Medicine, ShinjukuTokyoJapan
| | - Katsuhiro Mikami
- Faculty of Biology‐Oriented Science and Technology, Kindai UniversityKinokawaWakayamaJapan
| | - Shunsuke Kikuchi
- Department of Orthopedic SurgeryKeio University School of Medicine, ShinjukuTokyoJapan
| | - Masaharu Nishikino
- The National Institutes for Quantum and Radiological Science and Technology Quantum Beam Science Research Directorate Kansai Photon Science InstituteKyotoJapan
| | - Toshiyuki Kitamura
- The National Institutes for Quantum and Radiological Science and Technology Quantum Beam Science Research Directorate Kansai Photon Science InstituteKyotoJapan
| | - Noboru Hasegawa
- The National Institutes for Quantum and Radiological Science and Technology Quantum Beam Science Research Directorate Kansai Photon Science InstituteKyotoJapan
| | - Morio Matsumoto
- Department of Orthopedic SurgeryKeio University School of Medicine, ShinjukuTokyoJapan
| | - Masaya Nakamura
- Department of Orthopedic SurgeryKeio University School of Medicine, ShinjukuTokyoJapan
| | - Takeo Nagura
- Department of Orthopedic SurgeryKeio University School of Medicine, ShinjukuTokyoJapan,Department of Clinical BiomechanicsKeio University School of Medicine, ShinjukuTokyoJapan
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