Correction Capability in the 3 Anatomic Planes of Different Pedicle Screw Designs in Scoliosis Instrumentation.

Abstract

Computer simulations to compare the correction capabilities of different pedicle screws in adolescent idiopathic scoliosis (AIS) instrumentations. To compare the correction and resulting bone-screw forces associated with different pedicle screws in scoliosis instrumentations. Pedicle screw fixation is widely used in surgical instrumentation for spinal deformity treatment. Screw design, correction philosophies, and surgical techniques are constantly evolving to achieve better control of the vertebrae and correction of the spinal deformity. Yet, there remains a lack of biomechanical studies that quantify the effects and advantages of different screw designs in terms of correction kinematics. The correction capabilities of fixed-angle, multiaxial, uniaxial, and saddle axial screws were kinematically analyzed, simulated, and compared. These simulations were based on the screw patterns and correction techniques proposed by 2 experienced surgeons for 2 AIS cases. Additional instrumentations were assessed to compare the correction and resulting bone-screw forces associated with each type of screw. The fixed-angle, uniaxial and saddle axial screws had similar kinematic behavior and performed better than multiaxial screws in the coronal and transverse planes (8% and 30% greater simulated corrections, respectively). Uniaxial and multiaxial screws were less effective than fixed-angle and saddle axial screws in transmitting compression/distraction to the anterior spine because of their sagittal plane mobility between the screw head and shank. Only the saddle axial screws allow vertebra angle in the sagittal plane to be independently adjusted. Pedicle screws of different designs performed differently for deformity corrections or for compensating screw placement variations in different anatomic planes. For a given AIS case, screw types should be determined based on the particular instrumentation objectives, the deformity's stiffness and characteristics so as to make the best of the screw designs.