Study design: Human cadaveric biomechanical study.
Objective: To determine the fixation strength of laterally directed, cortical pedicle screws under physiological loads.
Summary of background data: Lateral trajectory cortical pedicle screws have been described as a means of obtaining improved fixation while minimizing soft-tissue dissection during lumbar instrumentation. Biomechanical data have demonstrated equivalent strength in a quasi-static model; however, no biomechanical information is available comparing the fixation of cortical with traditional pedicle screws under cyclic physiological loads.
Methods: Seventeen vertebral levels (T11-L5) underwent quantitative computed tomography. On 1 side, a laterally directed, cortical pedicle screw was inserted with a traditional, medially directed pedicle screw placed on the contralateral side. With the specimen constrained in a testing apparatus, each screw underwent cyclic craniocaudal toggling under incrementally increasing physiological loads until 2 mm of head displacement occurred. Next, uniaxial pullout of each toggled screw was performed. The number of craniocaudal toggle cycles and load (N) required to achieve pedicle screw movement as well as axial pullout resistance (N) were compared between the 2 techniques.
Results: The mean trabecular bone mineral density of the specimens was 202 K2HPO4 mg/cm. Cortical pedicle screws demonstrated significantly improved resistance to toggle testing, requiring 184 cycles to reach 2 mm of displacement compared with 102 cycles for the traditional pedicle screws (P=0.002). The force necessary to displace the screws was also significantly greater for the cortical versus the traditional screws (398 N vs. 300 N, P=0.004). There was no statistical difference in axial pullout strength between the previously toggled cortical and traditional pedicle screws (1722 N vs. 1741 N, P=0.837).
Conclusion: Laterally directed cortical pedicle screws have superior resistance to craniocaudal toggling compared with traditional pedicle screws.
Level of evidence: N/A.