Study design: Randomized investigation of multiaxial pedicle screw mechanical properties.
Objectives: Measure static yield and ultimate strengths, yield stiffness, and fatigue resistance according to an established model. Compare these measured properties with expected loads in vivo.
Summary of background data: Multiaxial pedicle screws provide surgical versatility, but the complexity of their design may reduce their strength and fatigue resistance. There is no published data on the mechanical properties of such screws.
Materials and method: Screws were assembled according to a vertebrectomy model for destructive mechanical testing. Groups of five assemblies were tested in static tension and compression and subject to three cyclical loads. Modes of failure, yield, and ultimate strength, yield stiffness, and cycles to failure were determined for six designs of screw.
Results: Static compression yield loads ranged from 217.1 to 388.0 N and yield stiffness from 23.7 to 38.0 N/mm. Cycles to failure ranged from 42 x 10(3) to 4,719 x 10(3) at 75% of static ultimate load. There were significant differences between designs in all modes of testing. Failure occurred at the multiaxial link in static and cyclical compression.
Conclusions: Bending yield strengths just exceeded loads expected in vivo. Multiaxial designs had lower static bending yield strength than fixed screw designs. Five out of six multiaxial screw designs achieved one million cycles at 200 N in compression bending. "Ball-in-cup" multiaxial locking mechanisms were vulnerable to fatigue failure. Smooth surfaces and thicker material appeared to be protective against fatigue failure.