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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 5, 692-695.
doi: 10.1302/0301-620X.88B5.17422  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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The role of the dorsal vertebral cortex in the stability of transpedicular screws

A BIOMECHANICAL STUDY IN HUMAN CADAVERIC VERTEBRAE

D. Karataglis, MD, Orthopaedic Surgeon1; G. Kapetanos, MD, Professor2; A. Lontos, PhD, Mechanical Engineer3; A. Christodoulou, MD, Associate Professor1; J. Christoforides, MD, Associate Professor4; and J. Pournaras, MD, Professor1

1 First Orthopaedic Department, Aristotelian University of Thessaloniki, "G. Papanikolaou" General Hospital, 57010 Exohi, Thessaloniki, Greece.
2 Third Orthopaedic Department, Aristotelian University of Thessaloniki, "Papageorgiou" Hospital, 54629 Efkarpia, Greece.
3 Laboratory for Machine Tools and Manufacturing Engineering, School of Mechanical Engineering, Aristotelian University of Thessaloniki, Thessaloniki, Greece.
4 Second Orthopaedic Department, Aristelian University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece.

Correspondence should be sent to Dr D. Karataglis; e-mail: dkarataglis{at}yahoo.gr

The aim of this biomechanical study was to investigate the role of the dorsal vertebral cortex in transpedicular screw fixation. Moss transpedicular screws were introduced into both pedicles of each vertebra in 25 human cadaver vertebrae. The dorsal vertebral cortex and subcortical bone corresponding to the entrance site of the screw were removed on one side and preserved on the other. Biomechanical testing showed that the mean peak pull-out strength for the inserted screws, following removal of the dorsal cortex, was 956.16 N. If the dorsal cortex was preserved, the mean peak pullout strength was 1295.64 N. The mean increase was 339.48 N (26.13%; p = 0.033). The bone mineral density correlated positively with peak pull-out strength.

Preservation of the dorsal vertebral cortex at the site of insertion of the screw offers a significant increase in peak pull-out strength. This may result from engagement by the final screw threads in the denser bone of the dorsal cortex and the underlying subcortical area. Every effort should be made to preserve the dorsal vertebral cortex during insertion of transpedicular screws.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General