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Effect of surgical factors on the augmentation of cement- injectable cannulated pedicle screw fixation by a novel calcium phosphate-based nanocomposite |
Haolin Sun1,4, Chun Liu2, Shunlun Chen1, Yanjie Bai3, Huilin Yang2,4, Chunde Li1(), Lei Yang2,4,5() |
1. Department of Orthopedics, Peking University First Hospital, Beijing 100034, China 2. Orthopedic Institute, Department of Orthopedics, First Affiliated Hospital, Soochow University, Suzhou 215006, China 3. School of Public Health, Medical College, Soochow University, Suzhou 215100, China 4. International Research Center for Translational Orthopedics, Suzhou 215006, China 5. School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China |
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Abstract Bone cement-augmented pedicle screw system demonstrates great efficacy in spinal disease treatments. However, the intrinsic drawbacks associated with clinically used polymethylmethacrylate (PMMA) cement demands for new bone cement formulations. On the basis of our previous studies, a novel injectable and biodegradable calcium phosphate-based nanocomposite (CPN) for the augmentation of pedicle screw fixation was systematically evaluated for its surgical feasibility and biomechanical performance by simulated and animal osteoporotic bone models, and the results were compared with those of clinical PMMA cement. ASTM-standard solid foam and open-cell foam models and decalcified sheep vertebra models were employed to evaluate the augmentation effects of CPN on bone tissue and on the cement-injected cannulated pedicle screws (CICPs) placed in osteoporotic bone. Surgical factors in CICPs application, such as injection force, tapping technique, screw diameter, and pedicle screw loosening scenarios, were studied in comparison with those in PMMA. When directly injected to the solid foam model, CPN revealed an identical augmentation effect to that of PMMA, as shown by the similar compressive strengths (0.73±0.04 MPa for CPN group vs. 0.79±0.02 MPa for PMMA group). The average injection force of CPN at approximately 40–50 N was higher than that of PMMA at approximately 20 N. Although both values are acceptable to surgeons, CPN revealed a more consistent injection force pattern than did PMMA. The dispersing and anti-pullout ability of CPN were not affected by the surgical factors of tapping technique and screw diameter. The axial pullout strength of CPN evaluated by the decalcified sheep vertebra model revealed a similar augmentation level as that of PMMA (1351.6±324.2 N for CPN vs. 1459.7±304.4 N for PMMA). The promising results of CPN clearly suggest its potential for replacing PMMA in CICPs augmentation application and the benefits of further study and development for clinical uses.
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Keywords
bone cement
pedicle screw
degenerative spinal diseases
calcium phosphate
injectable
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Corresponding Author(s):
Chunde Li,Lei Yang
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Just Accepted Date: 01 August 2019
Online First Date: 23 September 2019
Issue Date: 14 October 2019
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