[Stability of pedicle screws in comparison to anterior vertebral body screws after kyphoplasty augmentation]

[Augmentation with PMMA cement]

Cements based on polymethyl methacrylate (PMMA) can be used without any problem in a variety of clinical augmentations. Cement-related complications in surgical procedures involving PMMA cements, such as embolism, thermal necrosis, toxicity and hypersensitivity, are often due to other causes. Knowledge about the properties of the cement helps the user to safely employ PMMA cements in augmentations. High radio-opacity is required in vertebral body augmentations and this is provided in particular by zirconium dioxide. In vertebral body augmentations, a low benzoyl peroxide (BPO) content can considerably prolong the liquid dough phase. In augmentations with cement fillings in the region of a tumor, a high BPO content can specifically increase the peak temperature of the PMMA cement. In osteosynthetic augmentations with PMMA, necrosis is rare because heat development in the presence of metallic implants is low due to heat conduction via the implant. Larger cement fillings where there is no heat conduction via metal implants can exhibit substantially higher peak temperatures. The flow properties of PMMA cements are of particular importance for the user to allow optimum handling of PMMA cements. In patients with hypersensitivity to antibiotics, there is no need to avoid the use of PMMA as there are sufficient PMMA-based alternatives. The PMMA cements are local drug delivery systems and antibiotics, antiseptics, antimycotics and also cytostatics can be mixed with the cement. Attention must be paid to antagonistic and synergistic effects.

Design and biomechanical testing of pedicle screw for osteoporotic incidents

In this study, geometrical features of pedicle screws have been modified and their performances are compared. Performance analysis has been made in terms of pull-out strength and torsional strength. The parameters investigated are core diameter, holes drilled normal to screw axis, angle between sequential holes and distance between holes. Three different core diameter have been studied, which are 4 mm (normal core diameter), 5 mm (medium core diameter) and 5.5 mm (high core diameter). Distance between sequential holes has been arranged such that there is either one hole per pitch or one hole per two pitches. Angle between sequential holes is either 90° or 120°. According to the test results, the screw, with medium core diameter (5 mm) containing one hole per two pitches with 90° angle between sequential holes, has exhibited the optimum performance considering torsional strength and pull-out strength requirements. Its torsional strength is slightly higher than and, when Grade 40 polyurethane foam was used as bone simulating material, its pull-out strength is as good as, an undrilled normal core diameter screw, which is already being used in surgical operations. The fatigue performance of this best performed screw has also been found satisfactory according to the related standard. Its pull-out strength is also tested on a calf vertebra and a promising result has been obtained.