A Novel Semi-Cannulated Screw Enhanced Bone Cement Augmentation and Pullout Strength in Posterior Cervical Lateral Mass Screw Fixations: An In Vitro Biomechanical and Morphological Study.

Abstract

To develop a novel semi-cannulated lateral mass screw (SC-LMS) for cervical posterior fixations and compare the fixation stability and safety of SC-LMS with regular solid lateral mass screw (S-LMS) in bone cement augmentation and pullout strength using fresh cadaveric cervical vertebrae. The conventional multiaxial screw for cervical lateral mass fixation was modified to a cannulated screw with two lateral holes, used for bone cement injection in situ. Eight fresh human cervical vertebrae (C3, C4, and C5) were collected and used. μCT scan was performed to evaluate the bone quality of the lateral masses, including bone mineral density (BMD), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). SCLMS or S-LMS were randomly inserted into the paired cervical vertebrae and pulled out as a screw loosening model. These screws were reinserted in with bone cement augmentation, scanned by μCT to obtain the bone cement distribution along the screws, and pulled out to test the screw purchase strength. Fmax values exhibited strong positive correlations with the local BMD (𝑟 = 0.8640, p < 0.0001) and Tb.Th (𝑟 = 0.6795, p = 0.0038), whereas a negative correlation with Tb.Sp (𝑟 = -0.5567, p = 0.0251). A significant difference was observed between the Fmax before and after PMMA injection on the SC-LMS side (p = 0.019). The SC-LMS exhibited lower risk of cement leakage than S-LMS after PMMA injection, and a positive correlation was observed between 𝐹max and the distribution volumes on the SC-LMS side. The novel SC-LMS provides more robust fixation stability and is safer than the S-LMS for PMMA augmentation, which may be related to the cement-screw-cement-bone complex formation.