David E Bauer, Luca Mari Major, Oliver Wigger, Ramon Rohner, Mazda Farshad, Jonas Widmer, Michael Betz
{"title":"一项生物力学尸体研究表明，预敲在腰椎内固定术中不能有效预防椎弓根骨折。","authors":"David E Bauer, Luca Mari Major, Oliver Wigger, Ramon Rohner, Mazda Farshad, Jonas Widmer, Michael Betz","doi":"10.1097/BRS.0000000000005384","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical cadaveric study.</p><p><strong>Objective: </strong>To evaluate whether pre-tapping reduces the risk of pedicle fractures following pedicle screw instrumentation.</p><p><strong>Summary of background data: </strong>Pedicle screw instrumentation is the standard for rigid fixation of the thoracolumbar spine. While complications such as screw loosening and misplacement are well-documented, pedicle fractures are rare and poorly understood. Pre-tapping, a technique used during screw insertion, has been proposed to enhance fixation strength and potentially reduce the risk of fractures. However, its biomechanical effects on pedicle integrity remain unclear.</p><p><strong>Methods: </strong>Twenty lumbar vertebrae (L1-L5) were harvested from four cadavers. Preoperative CT scans were used to plan screw trajectories and assess bone mineral density (BMD). Each vertebra was alternately instrumented with screws using pre-tapping and non-pre-tapping techniques. Biomechanical testing measured maximum bending force to failure under a flexion moment. Pedicle fractures were classified based on CT imaging, and statistical analysis was performed to evaluate factors influencing fracture risk.</p><p><strong>Results: </strong>The maximum bending force to failure showed no significant difference between pre-tapping (103.9±47.5 Nm) and non-pre-tapping (98.1±43.4 Nm) groups (P=0.321). Pre-tapping significantly reduced maximum insertion torque (1.30±1.05 Nm vs. 2.91±2.65 Nm, P=0.025). Pedicle fill was a significant predictor of bending force (β=222.29 Nm, P=0.035), while BMD and pedicle diameter were not. Fracture patterns did not differ significantly between groups (P=0.384).</p><p><strong>Conclusion: </strong>Pre-tapping does not significantly influence the biomechanical stability of pedicle screws or the risk of pedicle fractures under flexion moments. However, pedicle fill is a critical factor in screw fixation strength. These findings suggest that optimizing pedicle fill is more relevant than pre-tapping in enhancing construct stability.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pretapping is Not Effective in Preventing Pedicle Fractures in Lumbar Spinal Instrumentation: A Biomechanical Cadaveric Study.\",\"authors\":\"David E Bauer, Luca Mari Major, Oliver Wigger, Ramon Rohner, Mazda Farshad, Jonas Widmer, Michael Betz\",\"doi\":\"10.1097/BRS.0000000000005384\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Biomechanical cadaveric study.</p><p><strong>Objective: </strong>To evaluate whether pre-tapping reduces the risk of pedicle fractures following pedicle screw instrumentation.</p><p><strong>Summary of background data: </strong>Pedicle screw instrumentation is the standard for rigid fixation of the thoracolumbar spine. 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引用次数: 0
摘要
研究设计：生物力学尸体研究。目的：评价预叩是否能降低椎弓根螺钉置入后椎弓根骨折的风险。背景资料总结：椎弓根螺钉内固定是胸腰椎刚性固定的标准。虽然诸如螺钉松动和错位等并发症有充分的文献记载，但椎弓根骨折是罕见的，而且人们对其知之甚少。预攻丝是螺钉置入时使用的一种技术，可提高固定强度并潜在地降低骨折风险。然而，其对椎弓根完整性的生物力学影响尚不清楚。方法：选取4具尸体20节腰椎（L1-L5）。术前CT扫描用于规划螺钉轨迹和评估骨矿物质密度（BMD）。采用预攻螺钉和非预攻螺钉交替固定每个椎体。生物力学测试测量了在弯曲力矩作用下的最大弯曲力。根据CT影像对椎弓根骨折进行分类，并对影响骨折风险的因素进行统计分析。结果：预攻丝组（103.9±47.5 Nm）与未预攻丝组（98.1±43.4 Nm）最大弯曲力失效差异无统计学意义（P=0.321）。预攻丝显著降低了最大插入扭矩（1.30±1.05 Nm vs. 2.91±2.65 Nm， P=0.025）。椎弓根填充是弯曲力的显著预测因子（β=222.29 Nm， P=0.035），而骨密度和椎弓根直径则不是。两组间骨折类型差异无统计学意义（P=0.384）。结论：预叩对椎弓根螺钉的生物力学稳定性及屈曲力矩作用下椎弓根骨折风险无明显影响。然而，椎弓根填充是影响螺钉固定强度的关键因素。这些结果表明，优化椎弓根填充比预攻更能提高构建体的稳定性。
Pretapping is Not Effective in Preventing Pedicle Fractures in Lumbar Spinal Instrumentation: A Biomechanical Cadaveric Study.
Study design: Biomechanical cadaveric study.
Objective: To evaluate whether pre-tapping reduces the risk of pedicle fractures following pedicle screw instrumentation.
Summary of background data: Pedicle screw instrumentation is the standard for rigid fixation of the thoracolumbar spine. While complications such as screw loosening and misplacement are well-documented, pedicle fractures are rare and poorly understood. Pre-tapping, a technique used during screw insertion, has been proposed to enhance fixation strength and potentially reduce the risk of fractures. However, its biomechanical effects on pedicle integrity remain unclear.
Methods: Twenty lumbar vertebrae (L1-L5) were harvested from four cadavers. Preoperative CT scans were used to plan screw trajectories and assess bone mineral density (BMD). Each vertebra was alternately instrumented with screws using pre-tapping and non-pre-tapping techniques. Biomechanical testing measured maximum bending force to failure under a flexion moment. Pedicle fractures were classified based on CT imaging, and statistical analysis was performed to evaluate factors influencing fracture risk.
Results: The maximum bending force to failure showed no significant difference between pre-tapping (103.9±47.5 Nm) and non-pre-tapping (98.1±43.4 Nm) groups (P=0.321). Pre-tapping significantly reduced maximum insertion torque (1.30±1.05 Nm vs. 2.91±2.65 Nm, P=0.025). Pedicle fill was a significant predictor of bending force (β=222.29 Nm, P=0.035), while BMD and pedicle diameter were not. Fracture patterns did not differ significantly between groups (P=0.384).
Conclusion: Pre-tapping does not significantly influence the biomechanical stability of pedicle screws or the risk of pedicle fractures under flexion moments. However, pedicle fill is a critical factor in screw fixation strength. These findings suggest that optimizing pedicle fill is more relevant than pre-tapping in enhancing construct stability.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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