A biomechanical investigation of different screw head designs for vertebral derotation in scoliosis surgery

Po Yi Liu, Po Liang Lai*, Chun Li Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

10 Scopus citations

Abstract

Background Context The posterior pedicle screw-rod system, which is widely used to correct spinal deformities, achieves a good correction rate in the frontal and coronal planes but not in the axial plane. Direct vertebral derotation (DVD) was developed to correct axial plane deformities. However, the design of screw head and body connection, in terms of monoaxial, polyaxial, and uniplanar screw, may influence the efficiency of DVD. Purpose This study compared the efficiency of a newly designed uniplanar screw with that of monoaxial and polyaxial screws in the DVD maneuver. Study Design A porcine spine model and monoaxial, polyaxial, and uniplanar screws were used to examine the biomechanics of the DVD maneuver. Methods Six T7–T13 porcine thoracic spine segments were used as test specimens in this study. Pedicle screws were inserted in the left pedicles of the T9–T11 spinal segments and then connected with a rod. Three types of pedicle screws with different screw head designs (monoaxial, polyaxial, and uniplanar) were employed in this study. The material testing system (MTS) machine generated a rotational moment through the derotational tube on the T10 (apical body) pedicle screw, which simulated the motion applied during the surgical vertebral derotational procedure. The pedicle strain and the kinematics of the vertebral body and derotational tube were recorded to evaluate the derotational efficiency of different pedicle screw head designs. Results The variances of the derotation for the monoaxial, polyaxial, and uniplanar screws were 2.22°±1.43°, 32.23°±2.26°, and 4.75°±1.60°, respectively; the derotation efficiency was 0.65, 0.51, and 0.12, respectively, when the torques of the spinal constructs reached 3 Nm. The rotational variance of the polyaxial screw was statistically greater than that of the monoaxial and uniplanar screws (p<.05). The maximum micro-strains of the pedicles for the monoaxial, polyaxial, and uniplanar screws were 1,067.45±550.35, 747.68±393.56, and 663.55±271.04, respectively, with no statistically significant differences (p>.05). Conclusions The screw head design played an important role in the efficiency and variance of the derotation during the DVD maneuver. The derotational efficiency of the newly designed uniplanar screw was closer to that of the monoaxial screw group than to that of the polyaxial screw group. The polyaxial screw was inferior to DVD owing to a derotational variance between the derotational tube and the apical body that was correlated with the range of motion of the screw head. In the present study, the pedicle strain was similar in all groups. However, the pedicle strain of the uniplanar screw group was lower than that of the monoaxial screw group and was similar to that of the polyaxial screw group when the angle of rotation of the apical body increased.

Original languageEnglish
Pages (from-to)1171-1179
Number of pages9
JournalSpine Journal
Volume17
Issue number8
DOIs
StatePublished - 08 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

Keywords

  • Pedicle screw
  • pedicle strain
  • scoliosis
  • uniplanar screw
  • vertebral derotation
  • vertebral translation

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