Biomechanical comparison of a new undercut thread design vs. the V-shape thread design for pedicle screws

Abstract

<p>BACKGROUND CONTEXT: Thread shape is regarded as an important factor influencing the fixation strength and osseointegration of bone screws. However, commercial pedicle screws with a V-shaped thread are prone to generating stress concentration at the bone-screw interface, thereby increasing the risk of screw loosening. Thus, modification of the pedicle-screw thread is imperative. PURPOSE: This study aimed to investigate the fixation stability of pedicle screws with the new undercut thread design in comparison to pedicle screws with a V-shaped thread. STUDY DESIGN: In vitro cadaveric biomechanical test and finite element analysis (FEA). METHODS: Pedicle screws with the undercut thread (characterized by a flat crest feature and a tip-facing undercut feature) were custom-manufactured, whereas those with the V-shaped thread were procured from a commercial supplier. Fixation stability was assessed by the cyclic nonpullout compressive biomechanical testing on cadaveric female osteoporotic vertebrae. The vertical displacement and rotation angle of the 2 types of pedicle screws were calculated every 100 cycles to evaluate their resistance to migration and rotation. FEA was conducted to investigate the stress distribution and bone damage at the bone-screw interface for both types of pedicle screws. RESULTS: Biomechanical testing revealed that the pedicle screws with the undercut thread exhibited significantly lower vertical displacement and rotation angles than the pedicle screws with the V-shape thread (P < 0.05). FEA results demonstrated a more uniform stress distribution in the bone surrounding the thread in the undercut design than in the V-shape design. Additionally, bone damage resulting from the pedicle screw was lower in the undercut design than in the V-shape design. CONCLUSIONS: Pedicle screws with an undercut thread are less prone to migration and rotation and thus more stable in the bone than those with a V-shape thread. CLINICAL SIGNIFICANCE: The undercut thread design may reduce the incidence of pedicle-screw loosening.</p>