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      Biomechanical Evaluation of a Spinal Screw Fixation System by the Finite Element Method Translated title: Evaluación Biomecánica de un Sistema de Fijación Espinal con Tornillo por el Método de Elementos Finitos

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          Abstract

          The objective of the present study was to validate virtual models for the study of dual core and cylindrical screws and evaluate the influence of the geometry of the screws on the mechanical behavior and anchoring. Two models of dual core screws were used, one with a double thread and the other with a single thread, both with a conventional cylindrical screw were used in this study. The stiffness was assessed in a pullout test using polyurethane. Three dimensional virtual models simulating the pullout test were created for finite element analysis. To validate the models, the results were correlated with the mechanical tests. Tensions generated in polyurethane and the screw were studied while simulating the application of force in the direction of the screw pullout, of force transmitted by the rod with the individual standing at rest, and the force transmitted by the rod when performing flexion of the trunk. The dual core screws generated lower tensions in the polyurethane when compared to the cylindrical screw for the forces studied. When evaluating internal tension in the screw, lower levels of tension were presented in the dual core - double thread, higher levels were observed in dual core - single thread, this screw has a smaller internal diameter which may be responsible for this higher generated tension. The dual core screws double thread proportionated good anchorage with more diameter on the region with great tension, avoiding the fracture.

          Translated abstract

          El objetivo de la presente investigación fue validar modelos virtuales para el estudio de tornillos cilíndricos y de pedículo de doble núcleo para evaluar la influencia de la geometría éstos en su anclaje y comportamiento mecánico. Se utilizaron dos modelos de tornillos de doble núcleo, unos de rosca doble y otros de rosca única, ambos tipos conformados por un tornillo cilíndrico convencional. La rigidez se evaluó en una prueba de retirada, utilizando poliuretano. Se crearon tres modelos virtuales tridimensionales que permitieron simular la prueba de retirada para el análisis de elementos finitos. Para validar los modelos, los resultados se correlacionaron con ensayos mecánicos. Se estudiaron las tensiones generadas en el poliuretano y el tornillo a través de la simulación de la aplicación de la fuerza en la dirección de retirada del tornillo, de la fuerza transmitida por la varilla en el individuo en reposo de pie, y la fuerza transmitida por la varilla cuando se realizaba la flexión del tronco. Los tornillos de doble núcleo generan tensiones más bajas en el poliuretano en comparación con el tornillo cilíndrico, para las mismas fuerzas estudiadas. Cuando se evalúa la tensión interna en el tornillo, se presentaron niveles más bajos de tensión en el tornillo de doble rosca, en comparación a los niveles de tensión más altos presentados en los tornillos de rosca única, presentando este tornillo un diámetro interno más pequeño que puede ser responsable de la mayor tensión. Los tornillos de doble núcleo y doble rosca proporcionan un buen anclaje con mayor diámetro y tensión en la región a tratar, evitando la fractura.

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          Most cited references29

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          Complications associated with pedicle screws.

          The safety and the effectiveness of pedicle-screw instrumentation in the spine have been questioned despite its use worldwide to enhance stabilization of the spine. This review was performed to answer questions about the technique of insertion and the nature and etiology of complications directly attributable to the screws. We performed a retrospective review of all of the pedicle-screw procedures that were done by us from January 1, 1984, to December 31, 1993. We inserted 4790 screws during 915 operative procedures on 875 patients; 668 (76.3 percent) of the patients had a lumbosacral arthrodesis. The mean duration of follow-up was three years (range, two to five years). The accuracy of screw placement was assessed on intraoperative, immediate postoperative, and follow-up radiographs with use of a technique that was developed by one of us (F. D.); this technique has yet to be validated to determine the prevalence of various types of error. Of the 4790 screws, 4548 (94.9 percent) had been inserted within the pedicle and the vertebral body. One hundred and thirty-four (2.8 percent) of the screws had perforated the anterior cortex, and this was the most common type of perforation. One hundred and fifteen (2.4 percent) of the screws were associated with complications that could be ascribed to the use of pedicle screws. The most common problem was late-onset discomfort or pain related to a pseudarthrosis or perhaps to the screws; this problem was associated with 1102 (23.0 percent) of the screws, used in 222 (24.3 percent) of the procedures. The symptoms necessitated removal of the instrumentation with or without repair of the pseudarthrosis. A pseudarthrosis was found during forty-six (20.7 percent) of the 222 procedures. Irritation of a nerve root occurred after nine procedures (1.0 percent) and was caused by eleven screws (0.2 percent); it was more commonly caused by medially placed screws. Three patients had residual neurological weakness despite removal of the screws. Twenty-five screws (0.5 percent), used in twenty procedures (2.2 percent), broke. The screws that broke were of an early design. A pseudarthrosis was found in thirteen of twenty patients who had broken screws. Sixteen of the twenty patients had an exploration; three of them were found to have a solid fusion, and thirteen were found to have a pseudarthrosis. The remaining four patients had evidence of a solid fusion on radiographs and had no pain. There are few problems associated with the insertion of screws, provided that the surgeon is experienced and adheres to the principles and details of the operative technique. Our review revealed a low rate of postoperative complications related to pedicle screws. The problem of late-onset pain may be related to the implants or to the stiffness of the construct; however, it is difficult to accurately identify its exact etiology.
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            Structural characteristics of the pedicle and its role in screw stability.

            Cross-sectional regional bone mineral density of the pedicle was measured by peripheral quantitative computed tomography. Biomechanical tests were performed to clarify the role of the pedicle in screw stability. To identify the structural characteristics of the pedicle that supports pedicle screw stability and the differences in these characteristics between normal and osteoporotic vertebrae. The pedicle screw is an essential component of many systems used to align the spine. The contribution of the pedicle to screw stability, however, has not been fully investigated. Trabecular, subcortical, and cortical bone mineral density and the area of the pedicle were measured by peripheral quantitative computed tomography. Bone mineral density also was recalculated in four circumferential layers. These parameters were compared between normal and osteoporotic individuals. The relative contribution of the pedicle to screw stability was evaluated by caudocephalad and pull-out loading in a vertebra with or without its body. Inner trabecular, middle subcortical, and outer cortical bone mineral density and cortical bone area in the pedicle were significantly lower in osteoporotic vertebrae than those in normal vertebrae. In the pedicle, bone mineral density increased close to the outer layer. Bone mineral density not as thick even in the outer layer in osteoporotic subjects. Approximately 80% of the caudocephalad stiffness and 60% of the pullout strength of the pedicle screw depended on the pedicle rather than on the vertebral body. Screw stability depends on the structural characteristics of the pedicle. The pedicle was denser in the subcortical bone, in which the threads of the screw engage, than in trabecular bone. In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw would not enhance screw stability and may break the thin cortex in osteoporotic vertebrae.
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              Influence of bone mineral density on the fixation of thoracolumbar implants. A comparative study of transpedicular screws, laminar hooks, and spinous process wires.

              Posteriorly directed load to failure testing of four different types of spinal implants was performed in individual T5 to S1 vertebra harvested from seven fresh-frozen human cadaveric spines. The implants tested were: 1) Drummond spinous process wires, 2) Harrington laminar hooks, 3) Cotrel-Dubousset transpedicular screws, and 4) Steffee VSP transpedicular screws. The ultimate failure of each implant was compared with the bone mineral density of each vertebra to determine which implants, if any, were particularly advantageous in osteoporotic vertebrae. Before biomechanical testing, the spines were analyzed in vitro by dual photon absorptiometry to determine the bone mineral densities (gm/cm2) of each vertebra. The mean tensile loads to failure for each of the implants tested were as follows: Cotrel-Dubousset transpedicular screws: 345 Newtons; spinous process wire/button: 382 Newtons; Steffee transpedicular screws: 430 Newtons; and laminar hooks: 646 Newtons. The difference between the loads to failure for laminar hooks and the other implants was significant (P less than 0.05) using one-way analysis of variance. The overall correlation coefficient for bone mineral density with ultimate load to failure was 0.30 (P less than 0.001). The correlation coefficients were 0.47 (P less than 0.001) for spinous process wires alone; 0.096 (not significant) for laminar hooks alone; 0.37 (P less than 0.001) for Cotrel-Dubousset pedicle screws; and 0.48 (P less than 0.001) for Steffee pedicle screws. Of the four different implants tested, laminar hooks were most resistant to failure from posteriorly directed forces.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                ijmorphol
                International Journal of Morphology
                Int. J. Morphol.
                Sociedad Chilena de Anatomía (Temuco, , Chile )
                0717-9502
                March 2015
                : 33
                : 1
                : 318-326
                Affiliations
                [02] orgnameUniversity of São Paulo orgdiv1School of Dentistry of Ribeirão Preto orgdiv2Department of Morphology, Physiology, and Basic Pathology Brazil
                [01] São Paulo orgnameUniversity of São Paulo orgdiv1Faculty of Medicine of Ribeirão Preto orgdiv2Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus Brazil
                Article
                S0717-95022015000100050 S0717-9502(15)03300100050
                cf451f07-491d-4a4d-8c7f-8eeb78d8d902

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 January 2015
                : 23 October 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 9
                Product

                SciELO Chile


                Tornillos,Método de elementos finitos,Dispositivos de fijación de la columna vertebral,Finite element analysis,Spine fixation devices,Bone screws

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