• Yuichiro Goda, Kosaku Higashino, Shunichi Toki, Daisuke Suzuki, Takuma Kobayashi, Tetsuya Matsuura, Mineko Fujimiya, Williams C Hutton, Yoshihiro Fukui, and Koichi Sairyo.
• *Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School†Department of Orthopaedics‡Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan§Atlanta Veterans Affairs Medical Center and the Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA¶Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan.
• Spine. 2016 Aug 1; 41 (15): 1218-23.

Study DesignUsing fresh cadavers, the biomechanical testing were used to examine the pullout strength of each pedicle screw.ObjectiveThe aim of this study was to evaluate pullout strength of (1) a redirected pedicle screw following lateral wall breach; (2) a redirected pedicle screw following end-plate breach; and (3) a pedicle without redirection after end-plate breach without redirection.Summary Of Background DataScrew malposition, such as lateral wall breach or end-plate breach, is one of the main pitfalls of inserting pedicle screws.MethodsFrom 17 fresh spines, 54 vertebrae were harvested. In each vertebra on one pedicle, the screw was inserted correctly down the axis of the pedicle, while on the other pedicle, the screw was inserted to breach the lateral wall or the end-plate. The 18 pedicle screws that breached the lateral wall were then removed and redirected along the correct axis of the pedicle. The 18 pedicle screws that breached the end-plate were removed and redirected along the correct axis of the pedicle. The 18 other pedicle screws that had breached the end-plate were not removed. The pullout force of pedicle screws was measured.ResultsFirst, the mean pullout strength for the redirected screws following lateral wall breach was 24.0% less as compared with the correctly aligned screws. Second, the mean pullout strength for the redirected screws following end-plate breach was 23.3% less as compared with the correctly aligned screws. Third, the mean pullout strength for the pedicle screws end-plate breach was 7.6% less as compared with the correctly aligned screws.ConclusionThe pullout strength of redirected pedicle screws after either a lateral pedicle breach or end-plate breach is significantly less than the pullout strength of correctly aligned screw. A pedicle screw that is not redirected after end-plate breach is weaker than a pedicle screw correctly aligned; however, the difference is not significant.Level Of EvidenceN/A.

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