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Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements

  • Biomechanics
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

A basic science, hypothesis-driven experimental study of the biomechanics of two bone cements in their ability to augment pedicle screws in bone foam.

Objective

The purpose of our study was to compare the pullout and torque resistance of conventional pedicle screws (CPS) augmented with either polymethylmethacrylate (PMMA) or poly-dicalcium phosphate dihydrate (P-DCPD) cement in polyurethane foam blocks mimicking osteoporotic bone.

Summary of background data

P-DCPD cement has attractive safety characteristics such as non-exothermic curing and drug-eluting capacity. PMMA cement lacks these safety features yet is the current standard in pedicle screw augmentation.

Methods

Standardized low-density polyurethane open-cell foam blocks were instrumented with conventional pedicle screws and categorized into three groups of six each. Group 1 was the control group and no cement was used. Groups 2 and 3 were augmented with PMMA and P-DCPD, respectively. An Instron machine applied an axial load to failure at a rate of 2 mm/min for 3 min and a torsional load to failure at a rate of 1°/s. Failure was defined by an evident drop in the load after maximum value.

Results

Maximal pullout load for PMMA and P-DCPD was significantly greater than control (p < 0.0001). Interestingly, there was no significant difference in the pullout load to failure for the PMMA and P-DCPD groups. Analysis showed significant difference in torsional resistance between PMMA and P-DCPD, with PMMA having greater resistance (p = 0.00436).

Conclusions

No difference was observed between PMMA and P-DCPD in pullout load to failure conducted in low-density open-cell, rigid foam blocks. Although a significant difference did exist in our torque analysis, the clinical significance of such a load on a native spine is questionable. Further investigation is warranted for this promising compound that seems to be comparable in pullout resistance to PMMA and offers attractive safety features.

Level of evidence

Basic science, not applicable.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Detroit Medical Center, 4201 St Antoine St, Detroit, MI, 48201, USA

    Alberto Criado, Sanar Yokhana, Scott McCarty & Walid Khaled Yassir

  2. Wayne State University School of Medicine, 7733 Woodward Ave, Detroit, MI, 48202, USA

    Tahsin Rahman

  3. Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI, 48201, USA

    Christopher Andrecovich & Weiping Ren

Authors
  1. Alberto Criado
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  2. Sanar Yokhana
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  3. Tahsin Rahman
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  4. Scott McCarty
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  5. Christopher Andrecovich
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  6. Weiping Ren
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  7. Walid Khaled Yassir
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Corresponding author

Correspondence to Tahsin Rahman.

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AC (none), SY (none), TR (none), SM (none), CA (none), WR (none), WKY (none).

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Criado, A., Yokhana, S., Rahman, T. et al. Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements. Spine Deform 8, 165–170 (2020). https://doi.org/10.1007/s43390-019-00022-2

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  • DOI: https://doi.org/10.1007/s43390-019-00022-2

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