Osseointegration improves bone-implant interface of pedicle screws in the growing spine: a biomechanical and histological study using an in vivo immature porcine model.

Abstract

Implant failure is a frequent complication in corrective surgery for early onset scoliosis, since considerable forces are acting on small and fragile vertebrae. Osseointegration showing biomechanical and histological improvement in bone-implant interface (BII) after dental implant placement has been well investigated. However, there are no studies regarding osseointegration in immature vertebral bone. The purpose was to evaluate the timecourse of biomechanical and histological changes at BII after pedicle screw placement using in vivo immature porcine model. Ten immature porcine were instrumented with titanium pedicle screws in the thoracic spine. After a 0-, 2-, 4-, and 6-month survival periods, the spines were harvested at the age of 12months. Histological evaluation of BII was conducted by bone volume/tissue volume (BV/TV) and bone surface/implant surface (BS/IS) measurements. Bone mineral density (BMD) measurement and biomechanical testing of BII were done. Contact surface and bone volume around the screw threads were significantly increased over the time. BV/TV and BS/IS were improved with statistically significant differences between 0- and ≥4-month (p≤0.001) periods. BMD in all subjects was determined to be the same (p≥0.350). Pullout strength was also increased over time with significant differences between 0- and ≥2-month (p≤0.011) periods. Improved stability at BII caused by osseointegration was confirmed by in vivo immature porcine model. A two-stage operation is proposed based on the osseointegration theory, in which an implant is installed in advance in the vertebrae at the first stage and deformity correction surgery is performed after sufficient stability is obtained by osseointegration at a later stage.