- Department of Orthopedics, the Affiliated First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China. Corresponding author: ZHU Yue, E-mail: zhuyuedr@163.com;
Objective To review the progress of the pedicle screw augmentation technique by bone cement. Methods Recent literature about the pedicle screw augmentation technique by bone cement was reviewed and analysed. The characters were summarized. Results Pedicle augmentation technique includes the augmentation of ordinary solid pedicle screw and hollow pedicle screw. Both types could increase the fixation strength and gain satisfactory clinical results. Bone cement leakage had a certain incidence rate, but most of cases were asymptom. Conclusion Bone cement augmentation of pedicle screw is an effective and safe internal fixation for poor bone condition.
Citation： LIU Xinchun,ZHU Yue.. PROGRESS OF BONE CEMENT AUGMENTATION OF PEDICLE SCREW. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(10): 1267-1272. doi: 10.7507/1002-1892.20130276 Copy
| 1. | Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17. |
| 2. | Zindrick MR, Wiltse LL, Widell EH, et al. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res, 1986, (203): 99-112. |
| 3. | Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976), 1994, 19(21): 2415-2420. |
| 4. | McLain RF, McKinley TO, Yerby SA, et al. The effect of bone quality on pedicle screw loading in axial instability: a synthetic model. Spine (Phila Pa 1976), 1997, 22(13): 1454-1460. |
| 5. | Margulies JY, Casar RS, Caruso SA, et al. The mechanical role of laminar hook protection of pedicle screws at the caudal end vertebra. Eur Spine J, 1997, 6(4): 245-248. |
| 6. | Hasegawa K, Takahashi HE, Uchiyama S, et al. An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine. Spine (Phila Pa 1976), 1997, 22(9): 958-963. |
| 7. | Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis. Spine (Phila Pa 1976), 2004, 29(16): 1723-1730. |
| 8. | Hu SS. Internal fixation in the osteoporotic spine. Spine (Phila Pa 1976), 1997, 22(24 Suppl): 43S-48S. |
| 9. | Ghani I, Kroeber M. Role of major revision spine surgery in recurrent adjacent segment osteoporotic vertebral body fracture: a case report. Arch Orthop Trauma Surg, 2012, 132(8): 1089-1094. |
| 10. | Cavagna R, Tournier C, Aunoble S, et al. Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation. J Spinal Disord Tech, 2008, 21(2): 86-91. |
| 11. | Polly DW Jr, Orchowski JR, Ellenbogen RG. Revision pedicle screws. Bigger, longer shims—what is best? Spine (Phila Pa 1976), 1998, 23(12): 1374-1379. |
| 12. | Kiner DW, Wybo CD, Sterba W, et al. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976), 2008, 33(24): 2618-2622. |
| 13. | Hirano T, Hasegawa K, Washio T, et al. Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord, 1998, 11(6): 493-497. |
| 14. | Cook SD, Salkeld SL, Whitecloud TS 3rd, et al. Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord, 2000, 13(3): 230-236. |
| 15. | Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114. |
| 16. | Aldini NN, Fini M, Giavaresi G, et al. Pedicular fixation in the osteoporotic spine: a pilot in vivo study on long-term ovariectomized sheep. J Orthop Res, 2002, 20(6): 1217-1224. |
| 17. | Hasegawa T, Inufusa A, Imai Y, et al. Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J, 2005, 5(3): 239-243. |
| 18. | Pfeifer BA, Krag MH, Johnson C. Repair of failed transpedicle screw fixation. A biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction. Spine (Phila Pa 1976), 1994, 19(3): 350-353. |
| 19. | Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408. |
| 20. | Soshi S, Shiba R, Kondo H, et al. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine (Phila Pa 1976), 1991, 16(11): 1335-1341. |
| 21. | Renner SM, Lim TH, Kim WJ, et al. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976), 2004, 29(11): E212-216. |
| 22. | Linhardt O, Lüring C, Matussek J, et al. Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement. J Spinal Disord Tech, 2006, 19(2): 87-91. |
| 23. | 邑晓东, 卢海霖, 陈明. 医用骨水泥在骨质疏松患者行椎弓根钉固定中的作用. 中国脊柱脊髓杂志, 2005, 15(2): 95-97. |
| 24. | Frankel BM, Jones T, Wang C. Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery, 2007, 61(3): 531-537. |
| 25. | Kim HS, Park SK, Joy H, et al. Bone cement augmentation of short segment fixation for unstable burst fracture in severe osteoporosis. J Korean Neurosurg Soc, 2008, 44(1): 8-14. |
| 26. | Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-324. |
| 27. | 王刚, 吴峰, 关宏刚, 等. 直入式注入聚甲基丙烯酸甲酯骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折. 中华创伤骨科杂志, 2011, 13(6): 549-552. |
| 28. | Aydogan M, Ozturk C, Karatoprak O, et al. The pedicle screw fixation with vertebroplasty augmentation in the surgical treatment of the severe osteoporotic spines. J Spinal Disord Tech, 2009, 22(6): 444-447. |
| 29. | Sawakami K, Yamazaki A, Ishikawa S, et al. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech, 2012, 25(2): E28-35. |
| 30. | Yazu M, Kin A, Kosaka R, et al. Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine. J Orthop Sci, 2005, 10(1): 56-61. |
| 31. | Fransen P. Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine, 2007, 7(3): 366-369. |
| 32. | Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc, 2009, 46(4): 305-311. |
| 33. | Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening. J Orthop Traumatol, 2011, 12(4): 193-199. |
| 34. | Piñera AR, Duran C, Lopez B, et al. Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation. Eur Spine J, 2011, 20 Suppl 3: 408-414. |
| 35. | Lubansu A, Rynkowski M, Abeloos L, et al. Minimally invasive spinal arthrodesis in osteoporotic population using a cannulated and fenestrated augmented screw: technical description and clinical experience. Minim Invasive Surg, 2012, 2012: 507826. |
| 36. | Goldring SR, Schiller AL, Roelke M, et al. The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J Bone Joint Surg (Am), 1983, 65(5): 575-584. |
| 37. | Whitehill R, Drucker S, McCoig JA, et al. Induction and characterization of an interface tissue by implantation of methylmethacrylate cement into the posterior part of the cervical spine of the dog. J Bone Joint Surg (Am), 1988, 70(1): 51-59. |
| 38. | Moore DC, Maitra RS, Farjo LA, et al. Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine (Phila Pa 1976), 1997, 22(15): 1696-1705. |
| 39. | Wuisman PI, Van Dijk M, Staal H, et al. Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J, 2000, 9(6): 528-533. |
| 40. | Masaki T, Sasao Y, Miura T, et al. An experimental study on initial fixation strength in transpedicular screwing augmented with calcium phosphate cement. Spine (Phila Pa 1976), 2009, 34(20): E724-728. |
| 41. | Watson JT. The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics, 2004, 27(1 Suppl): s103-107. |
| 42. | 卢海霖, 郑辉, 邑晓东, 等. 可注射硫酸钙MIIGX3与医用骨水泥对椎弓根钉固定作用的比较研究. 中国矫形外科杂志, 2006, 14(10): 760-761. |
| 43. | Urban RM, Turner TM, Hall DJ, et al. Effect of altered crystalline structure and increased initial compressive strength of calcium sulfate bone graft substitute pellets on new bone formation. Orthopedics, 2004, 27(1 Suppl): s113-118. |
| 44. | Derincek A, Wu C, Mehbod A, et al. Biomechanical comparison of anatomic trajectory pedicle screw versus injectable calcium sulfate graft-augmented pedicle screw for salvage in cadaveric thoracic bone. J Spinal Disord Tech, 2006, 19(4): 286-291. |
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| 48. | 张树芳, 江建明, 郭婷, 等. geneX 骨水泥强化骨质疏松椎体椎弓根钉的生物力学研究. 中国骨与关节损伤杂志, 2012, 27(5): 421-423. |
| 49. | Zhu Q, Kingwell S, Li Z, et al. Enhancing pedicle screw fixation in the aging spine with a novel bioactive bone cement: an in vitro biomechanical study. Spine (Phila Pa 1976), 2012, 37(17): E1030-1037. |
| 50. | Burval DJ, McLain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10): 1077-1083. |
| 51. | Hu MH, Wu HT, Chang MC, et al. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J, 2011, 20(8): 1281-1288. |
| 52. | Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618. |
| 53. | Choma TJ, Pfeiffer FM, Swope RW, et al. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976), 2012, 37(26): E1628-1632. |
| 54. | Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine, 2007, 7(1): 47-53. |
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- 1. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
- 2. Zindrick MR, Wiltse LL, Widell EH, et al. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res, 1986, (203): 99-112.
- 3. Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976), 1994, 19(21): 2415-2420.
- 4. McLain RF, McKinley TO, Yerby SA, et al. The effect of bone quality on pedicle screw loading in axial instability: a synthetic model. Spine (Phila Pa 1976), 1997, 22(13): 1454-1460.
- 5. Margulies JY, Casar RS, Caruso SA, et al. The mechanical role of laminar hook protection of pedicle screws at the caudal end vertebra. Eur Spine J, 1997, 6(4): 245-248.
- 6. Hasegawa K, Takahashi HE, Uchiyama S, et al. An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine. Spine (Phila Pa 1976), 1997, 22(9): 958-963.
- 7. Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis. Spine (Phila Pa 1976), 2004, 29(16): 1723-1730.
- 8. Hu SS. Internal fixation in the osteoporotic spine. Spine (Phila Pa 1976), 1997, 22(24 Suppl): 43S-48S.
- 9. Ghani I, Kroeber M. Role of major revision spine surgery in recurrent adjacent segment osteoporotic vertebral body fracture: a case report. Arch Orthop Trauma Surg, 2012, 132(8): 1089-1094.
- 10. Cavagna R, Tournier C, Aunoble S, et al. Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation. J Spinal Disord Tech, 2008, 21(2): 86-91.
- 11. Polly DW Jr, Orchowski JR, Ellenbogen RG. Revision pedicle screws. Bigger, longer shims—what is best? Spine (Phila Pa 1976), 1998, 23(12): 1374-1379.
- 12. Kiner DW, Wybo CD, Sterba W, et al. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976), 2008, 33(24): 2618-2622.
- 13. Hirano T, Hasegawa K, Washio T, et al. Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord, 1998, 11(6): 493-497.
- 14. Cook SD, Salkeld SL, Whitecloud TS 3rd, et al. Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord, 2000, 13(3): 230-236.
- 15. Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114.
- 16. Aldini NN, Fini M, Giavaresi G, et al. Pedicular fixation in the osteoporotic spine: a pilot in vivo study on long-term ovariectomized sheep. J Orthop Res, 2002, 20(6): 1217-1224.
- 17. Hasegawa T, Inufusa A, Imai Y, et al. Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J, 2005, 5(3): 239-243.
- 18. Pfeifer BA, Krag MH, Johnson C. Repair of failed transpedicle screw fixation. A biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction. Spine (Phila Pa 1976), 1994, 19(3): 350-353.
- 19. Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408.
- 20. Soshi S, Shiba R, Kondo H, et al. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine (Phila Pa 1976), 1991, 16(11): 1335-1341.
- 21. Renner SM, Lim TH, Kim WJ, et al. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976), 2004, 29(11): E212-216.
- 22. Linhardt O, Lüring C, Matussek J, et al. Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement. J Spinal Disord Tech, 2006, 19(2): 87-91.
- 23. 邑晓东, 卢海霖, 陈明. 医用骨水泥在骨质疏松患者行椎弓根钉固定中的作用. 中国脊柱脊髓杂志, 2005, 15(2): 95-97.
- 24. Frankel BM, Jones T, Wang C. Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery, 2007, 61(3): 531-537.
- 25. Kim HS, Park SK, Joy H, et al. Bone cement augmentation of short segment fixation for unstable burst fracture in severe osteoporosis. J Korean Neurosurg Soc, 2008, 44(1): 8-14.
- 26. Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-324.
- 27. 王刚, 吴峰, 关宏刚, 等. 直入式注入聚甲基丙烯酸甲酯骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折. 中华创伤骨科杂志, 2011, 13(6): 549-552.
- 28. Aydogan M, Ozturk C, Karatoprak O, et al. The pedicle screw fixation with vertebroplasty augmentation in the surgical treatment of the severe osteoporotic spines. J Spinal Disord Tech, 2009, 22(6): 444-447.
- 29. Sawakami K, Yamazaki A, Ishikawa S, et al. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech, 2012, 25(2): E28-35.
- 30. Yazu M, Kin A, Kosaka R, et al. Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine. J Orthop Sci, 2005, 10(1): 56-61.
- 31. Fransen P. Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine, 2007, 7(3): 366-369.
- 32. Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc, 2009, 46(4): 305-311.
- 33. Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening. J Orthop Traumatol, 2011, 12(4): 193-199.
- 34. Piñera AR, Duran C, Lopez B, et al. Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation. Eur Spine J, 2011, 20 Suppl 3: 408-414.
- 35. Lubansu A, Rynkowski M, Abeloos L, et al. Minimally invasive spinal arthrodesis in osteoporotic population using a cannulated and fenestrated augmented screw: technical description and clinical experience. Minim Invasive Surg, 2012, 2012: 507826.
- 36. Goldring SR, Schiller AL, Roelke M, et al. The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J Bone Joint Surg (Am), 1983, 65(5): 575-584.
- 37. Whitehill R, Drucker S, McCoig JA, et al. Induction and characterization of an interface tissue by implantation of methylmethacrylate cement into the posterior part of the cervical spine of the dog. J Bone Joint Surg (Am), 1988, 70(1): 51-59.
- 38. Moore DC, Maitra RS, Farjo LA, et al. Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine (Phila Pa 1976), 1997, 22(15): 1696-1705.
- 39. Wuisman PI, Van Dijk M, Staal H, et al. Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J, 2000, 9(6): 528-533.
- 40. Masaki T, Sasao Y, Miura T, et al. An experimental study on initial fixation strength in transpedicular screwing augmented with calcium phosphate cement. Spine (Phila Pa 1976), 2009, 34(20): E724-728.
- 41. Watson JT. The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics, 2004, 27(1 Suppl): s103-107.
- 42. 卢海霖, 郑辉, 邑晓东, 等. 可注射硫酸钙MIIGX3与医用骨水泥对椎弓根钉固定作用的比较研究. 中国矫形外科杂志, 2006, 14(10): 760-761.
- 43. Urban RM, Turner TM, Hall DJ, et al. Effect of altered crystalline structure and increased initial compressive strength of calcium sulfate bone graft substitute pellets on new bone formation. Orthopedics, 2004, 27(1 Suppl): s113-118.
- 44. Derincek A, Wu C, Mehbod A, et al. Biomechanical comparison of anatomic trajectory pedicle screw versus injectable calcium sulfate graft-augmented pedicle screw for salvage in cadaveric thoracic bone. J Spinal Disord Tech, 2006, 19(4): 286-291.
- 45. Yi X, Wang Y, Lu H, et al. Augmentation of pedicle screw fixation strength using an injectable calcium sulfate cement: an in vivo study. Spine (Phila Pa 1976), 2008, 33(23): 2503-2509.
- 46. Liu D, Lei W, Wu ZX, et al. Augmentation of pedicle screw stability with calcium sulfate cement in osteoporotic sheep: biomechanical and screw-bone interfacial evaluation. J Spinal Disord Tech, 2011, 24(4): 235-241.
- 47. Gao M, Lei W, Wu Z, et al. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon), 2011, 26(3): 238-244.
- 48. 张树芳, 江建明, 郭婷, 等. geneX 骨水泥强化骨质疏松椎体椎弓根钉的生物力学研究. 中国骨与关节损伤杂志, 2012, 27(5): 421-423.
- 49. Zhu Q, Kingwell S, Li Z, et al. Enhancing pedicle screw fixation in the aging spine with a novel bioactive bone cement: an in vitro biomechanical study. Spine (Phila Pa 1976), 2012, 37(17): E1030-1037.
- 50. Burval DJ, McLain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10): 1077-1083.
- 51. Hu MH, Wu HT, Chang MC, et al. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J, 2011, 20(8): 1281-1288.
- 52. Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618.
- 53. Choma TJ, Pfeiffer FM, Swope RW, et al. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976), 2012, 37(26): E1628-1632.
- 54. Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine, 2007, 7(1): 47-53.
- 55. Paré PE, Chappuis JL, Rampersaud R, et al. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976), 2011, 36(18): E1210-1214.
- 56. Fölsch C, Goost H, Figiel J, et al. Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement. Biomed Tech (Berl), 2012, 57(6): 473-480.
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