Effect of bone material properties on effective region in screw-bone model: an experimental and finite element study
- Shuai Liu†1,
- Wei Qi†1, 2,
- Yang Zhang†1,
- Zi-Xiang Wu1,
- Ya-Bo Yan1Email author and
- Wei Lei1Email author
© Liu et al.; licensee BioMed Central Ltd. 2014
Received: 9 February 2014
Accepted: 17 June 2014
Published: 21 June 2014
There have been numerous studies conducted to investigate the pullout force of pedicle screws in bone with different material properties. However, fewer studies have investigated the region of effect (RoE), stress distribution and contour pattern of the cancellous bone surrounding the pedicle screw.
Screw pullout experiments were performed from two different foams and the corresponding reaction force was documented for the validation of a computational pedicle screw-foam model based on finite element (FE) methods. After validation, pullout simulations were performed on screw-bone models, with different bone material properties to model three different age groups (<50, 50–75 and >75 years old). At maximum pullout force, the stress distribution and average magnitude of Von Mises stress were documented in the cancellous bone along the distance beyond the outer perimeter pedicle screw. The radius and volume of the RoE were predicted based on the stress distribution.
The screw pullout strengths and the load–displacement curves were comparable between the numerical simulation and experimental tests. The stress distribution of the simulated screw-bone vertebral unit showed that the radius and volume of the RoE varied with the bone material properties. The radii were 4.73 mm, 5.06 mm and 5.4 mm for bone properties of ages >75, 75 > ages >50 and ages <50 years old, respectively, and the corresponding volumes of the RoE were 6.67 mm3, 7.35 mm3 and 8.07 mm3, respectively.
This study demonstrated that there existed a circular effective region surrounding the pedicle screw for stabilization and that this region was sensitive to the bone material characteristics of cancellous bone. The proper amount of injection cement for augmentation could be estimated based on the RoE in the treatment of osteoporosis patients to avoid leakage in spine surgery.
KeywordsBiomechanics Pedicle screw Cancellous bone Finite element analysis
Osteoporosis is a common skeletal disorder of the spine and hip in the elderly population. Spine surgeons often encounter patients with osteoporotic spines that require spinal decompression and management with surgical instrumentation due to degenerative and traumatic spinal diseases [1, 2]. Pedicle screw fixation is a routine tool for spine stabilization, with the screw providing rigid bony secured points on internal fixation devices. However, it is a challenge for spine surgeons to perform pedicle screw instrumentation surgery on osteoporotic spines to prevent many potential complications, such as screw loosening, migration or back-out . It has been reported that the mechanical strength of the bone-screw interface is adversely affected by low bone density in patients with osteoporosis [4, 5].
Different methods have been used to enhance the short- and long-term stability of implanted screws in the osteoporotic lumbar spine [6, 7]. The in situ injection of biomaterials, such as calcium phosphate cement (CPC), calcium sulfate cement (CSC), and polymethyl-methacrylate (PMMA), into the screw hole is a common option for enhancing pedicle screw fixation strength [8, 9]. Although pedicle screw augmentation with cement is an attractive option for improving screw fixation, there exist risks of excessive cement leakage beyond the confined target bone, affecting the spinal cord and resulting in nerve compression . A smaller-volume cement injection might not enhance the augmentation screw performance.
Although there have been many experimental screw-bone interaction studies, it is technically difficult to determine the region of effect (RoE) by observing the screw-bone interaction during pullout testing. Sources in the literature have reported that the pullout strength of the pedicle screw increased from 147% to 300% [9–12] when the amount of cement injection varied from approximately 1 to 3.5 ml. Liu et al.  and Chang et al.  demonstrated that an appropriate volume of injection could be obtained by investigating of the interaction between the pedicle screw and cancellous bone. Compared to experimental models, finite element (FE) models provide the opportunity to document related mechanical responses during simulation . Some researchers have used FE models for screw-bone interaction studies. Moazen M et al.  evaluated the screw–bone interface model in a locking plate fixation through a corroboration study. Zhang et al.  developed a quarter screw-bone model and studied the effects of the bone material on the screw pullout strength. Chatzistergos et al.  used a two-dimensional screw-bone model to perform a parametric study of pedicle screw design. Because the pullout force is set as the dominant index for the evaluation of screw fixation, there have been numerous studies conducted regarding in this aspect, with fewer researchers investigating RoE, stress distribution and the contour pattern of the cancellous bone surrounding the pedicle screw.
Based on the pullout experiments [6, 7, 17] and micro-structural studies of the vertebral cancellous bone [18, 19], we speculated that there existed an effective region or an enclosed RoE around the perimeter of the pedicle screw that might play a pivotal role in the stabilization of the pedicle screw during screw pullout. Therefore, the purpose of this study was to investigate the existence of a region of effect in the pedicle screw pullout procedure and the sensitivity of this region to the material properties of the cancellous bone. Accordingly, an experimentally validated three-dimensional FE model of a screw-bone unit was established and used to determine the RoE in screw pullout simulations.
The screw-foam samples were prepared according to the surgical procedure. First, guiding holes with diameters of 3.5 mm and depths of 50 mm were drilled into the polyurethane blocks, and these guiding holes were then tapped manually, using the taps provided by the manufacturer (CD Horizon legacy MD-8 system, Medtronic Sofamor Danek Inc., Memphis, TN, USA). Finally, the 6.5 × 40-mm pedicle screws with 13 threads were screwed into the the polyurethane block to the full dept. The guiding holes were 10 mm deeper than the desired screw insertion depth, to ensure that the tip of the screw was not pressed against the bottom of the guiding hole, thus avoiding the generation of undesired pretension on the foams block . Sixteen pedicle screws were randomly divided into two groups and were screwed into the polyurethane blocks.
FE model design
Because the screw-bone interface was periodically symmetric, and a linear correlation existed between the number of threads and pullout strength [15, 16], a quarter unit model with only one thread was established for computational efficiency. Three FE models were developed: two screw-foam models were used for the validation study, and one screw-bone model was used for the material sensitivity analysis. Using Pro/Engineer software (PTC, Needham, MA, USA), based on the dimensions and profiles of the screw thread specifications of the standard pedicle screws [16, 23], the correct geometries of the pedicle screws were created. Separately, a quarter cylindrical block, 18 mm in diameter and 4 mm in length, was created. A threaded hole that matched the pedicle screw profile was created at the center of the block. The created three-dimensional geometries were then imported into ANSYS/LS-Dyna (ANSYS Inc., Canonsburg, PA, USA) for FE mesh generation.
To simulate the contacts between the foam/bone and screws at their interfaces under pullout loading conditions, the surface-to-surface contact relationship was employed in the model. Contact pairs were defined between the foam/bone and screws, with the trailing edge of the screw chosen as the master surface and those elements of the foam/bone chosen as the slave surface.
FE model validation
with N = 13 to correlate with those in the current experiment and in the studies by Hashemi et al. .
Calculation of RoE in cancellous bone: material sensitivity analysis
r: Outer radius (mm) of pedicle screw;
Δr: Radius (mm) of RoE;
L: The purchase depth (mm) of pedicle screw into the cancellous bone of vertebral body
At maximum pullout force, the stress distribution and magnitude in the cancellous bone along Δr beyond the outer perimeter pedicle screw was also documented.
Experimental study and FE model validation
Comparison of predicted screw pullout strength against those in current test and the published literature
Validation against our test
Validation against the test in literature
The current experiment (n = 8)
Hashemi et al.’s experiment (n > 4)
2015 ± 95.7 N
2132.5 ± 119.3 N
657 ± 69.4 N
688.2 ± 91.4 N
The stress distribution around the pedicle screw and material sensitivity analysis
The pullout force (PF) in blocks with different material properties
Age > 75 yrs
75 yrs > age > 50 yrs
50 yrs > age
The RoE in blocks around the pedicle screws with different material properties
Age > 75 yrs
75 yrs > age > 50 yrs
50 yrs > age
In the current study, an experimentally validated FE screw-bone model was established for the pullout simulation study, and the region of effect was investigated for pedicle screw stabilization around the pedicle screw during a pullout procedure. The results also showed that there existed a circular region in the cancellous bone around the pedicle screw, and this circular region was sensitive to the material properties of the cancellous bone.
The current study could provide spine surgeons with a clinical reference for pedicle screw instrumentation and augmentation. Many experimental studies have demonstrated that the stiffness and strength of pedicle screw-bone fixation could be significantly enhanced for screws augmented with various cements. Recently, several clinical studies have been conducted to investigate the application of cement augmentation for pedicle screw techniques [2, 9, 31]. However, cement has not been widely applied for pedicle screw augmentation clinically because of safety considerations. Moreover, a practical and reliable surgical technique for the augmentation of pedicle screws with cement has not yet been developed. Cement has many advantages for pedicle screw augmentation due to its high strength and rapid solidification, but an excessive volume of cement injection and posterior leakage of cement into the spinal canal can be catastrophic [32, 33]. Based on the results of the current study, the augmentation of the hypothetical region of effect could improve the stability of pedicle screws, and an appropriate volume of cement injection could be established for clinical reference.
The FE screw-foam models, based on pedicle screw CHH 6.5, were developed for pullout simulations in the current study and were validated against the experimental pullout test conducted in Hashemi et al.’s study . The screw pullout forces, extracted from two density screw-foam experimental tests and from simulated FE screw-foam models, showed direct proportionality to the strength of the material properties of the foam. The predicted pullout force and the load–displacement curves from the FE screw-foam models were of the same order of magnitude and showed similar trends with experimental results in Hashemi et al.’s study , as shown in Figure 5. These results demonstrated that FE screw-foam models were applicable for screw-bone pullout simulation, with appropriate material properties, allowing for the assumption of modeling the microstructure of cancellous bone as a cellular solid .
By changing the material of the mesh for the foam to that of cancellous bone, a modified FE screw-bone model was adopted for the pullout simulation to predict the pullout force and the hypothetical effective region (RoE) for screw stabilization. The FE computed results showed that the stress distribution pattern in cancellous bone around the pedicle screw was circular in shape. The stress magnitude was the highest in the region near the pedicle screw, and it decreased with the distance from the screw. This result supported the hypothesis that there existed a circular region around the pedicle screw, called the region of effect, which could play a pivotal role in screw stabilization.
As shown in the results, the range of RoE and screw pullout forces were affected by the mechanical properties of cancellous bone. However, Morgan et al.  and Hou et al.  reported that the material properties (density, stiffness, ultimate strength and yield strength) of cancellous bone changed with age. Therefore, with the different values of cancellous bone, Young’s modulus (in various appropriate age groups) was used in the current study, and the corresponding predicted stress magnitudes in the cancellous bone showed that the RoE decreased with bone properties. The present study showed that Δr ranged from 4.73 to 5.40 mm for standard 6.5 lumbar of specified thread profiles, and this range could vary depending on the screw type and thread profile (such as the thread shape factor and the inclination of the leading edge), which will be investigated in a further study.
In this study, the predicted RoE is based on the stress contour during the pullout simulation. The region with higher stress (near the pedicle screw) plays an important role in stabilizing the pedicle screw. The region with lower stress (distance away from the pedicle screw) carries less of a load in stabilizing the pedicle screw. We adopted the region with a von Mises stress value < 0.01 MPa to be ineffective in the stabilization of the pedicle screw. Based on the material properties of the cancellous bone, with minimum yield stress of the cancellous bone in the age > 75 years old group of 0.615 MPa, and the value of 0.01 MPa less than 2% of the yield stress, the region with von Mises stress value < 0.01 MPa could therefore play a minor role in pedicle screw stabilization.
The development of any computational model requires a number of assumptions regarding the geometry, materials, and interactions between components. In the present study, the model was a quarter screw-foam/bone unit excluding the cortical bone. The commonly used standard of the 6.5 mm pedicle screw type in clinical application for fixation in osteoporotic patients was used in the modeling. Elastic-perfect plastic material properties were adopted for cancellous bone tissue in the current study, based on the Hayes et al.’s study , and these properties were sufficient for the relatively simple loading conditions for screw pullout. In the present simulation, 60% strain was used as the failure standard of the cancellous bone tissue . Although the yield stress in cancellous bone occurs at strains of 5-10%, the strain usually exceeds 60% before failure in the cellular structure of cancellous bone [26, 35]. The friction coefficient between the screw and cancellous bone was set at 0.2, based on previous studies [15, 36]. In addition, a quarter screw-bone unit with fine mesh (mesh size: 0.1 mm; elements number: 99,354) was established in the present study for computational efficiency. In the present study, the RoE was calculated without considering the material properties of the injection cement. Although the calculated RoE in the current simulation was a circular region around the outer radius of the pedicle screw, the RoE could change with the injection of various cements. We speculate that the properties of injection could influence the RoE, that cement with a higher Young’s modulus, like PMMA, could enlarge the RoE in the cancellous bone, and that the RoE of biodegradable cement, such as CPC or hydroxyapatite, could vary with absorption of the biomaterials. Cancellous bone with various cement augmentations for pedicle screws requires further investigation.
In conclusion, the RoE was calculated based on an experimentally validated FE model in the present study. The results showed that there existed a circular region of effect around the pedicle screw during the pullout simulation. The RoE was sensitive to the material properties of the cancellous bone. The results suggested that the RoE could play a significantly role in pedicle screw augmentation, and the proper amount of injection cement for augmentation could be estimated in the treatment of osteoporosis patients for spine surgery.
SL: Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, China;
WQ: Surgery Department of 520th Hospital of PLA, Mian yang, China;
YZ: Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, China;
ZXW: Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, China;
YBY: Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, China;
WL: Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, China.
Shuai Liu, Wei Qi and Yang Zhang are the co-first authors.
The authors acknowledge the Chinese Scholarship Council (CSC) for the financial support on the international exchange.
- Allen RT, Lee YP, Garfin SR: Spine surgeons survey on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis. Spine J 2009,9(7):602–604.View ArticleGoogle Scholar
- Kim KH, Lee SH, Lee DY, Shim CS, Maeng DH: Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis. J Neurosurg Spine 2010,12(5):525–532.View ArticleGoogle Scholar
- Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC: Failure analysis of broken pedicle screws on spinal instrumentation. Med Eng Phys 2005,27(6):487–496.View ArticleGoogle Scholar
- Halvorson TL, Kelley LA, Thomas KA, Whitecloud TS 3rd, Cook SD: Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976) 1994,19(21):2415–2420.View ArticleGoogle Scholar
- Hasegawa K, Takahashi HE, Uchiyama S, Hirano T, Hara T, Washio T, Sugiura T, Youkaichiya M, Ikeda M: 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):958–962. discussion 963View ArticleGoogle Scholar
- Liu D, Lei W, Wu ZX, Gao MX, Wan SY, Fu SC, Shi L: 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.View ArticleGoogle Scholar
- Liu D, Wu ZX, Gao MX, Wan SY, Shi L, Fu SC, Wang J, Lei W: A new method of partial screw augmentation in sheep vertebrae in vitro: biomechanical and interfacial evaluation. J Spinal Disord Tech 2011,24(5):318–324.View ArticleGoogle Scholar
- Wuisman PI, Van Dijk M, Staal H, Van Royen BJ: 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.View ArticleGoogle Scholar
- 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-E324.View ArticleGoogle Scholar
- Burval DJ, McLain RF, Milks R, Inceoglu S: Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976) 2007,32(10):1077–1083.View ArticleGoogle Scholar
- Linhardt O, Luring C, Matussek J, Hamberger C, Plitz W, Grifka J: 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.View ArticleGoogle Scholar
- Yilmaz C, Atalay B, Caner H, Altinors N: Augmentation of a loosened sacral pedicle screw with percutaneous polymethylmethacrylate injection. J Spinal Disord Tech 2006,19(5):373–375.View ArticleGoogle Scholar
- MacLeod AR, Pankaj P, Simpson A: Does screw–bone interface modelling matter in finite element analyses? J Biomech 2012,45(9):1712–1716.View ArticleGoogle Scholar
- Moazen M, Mak JH, Jones AC, Jin Z, Wilcox RK, Tsiridis E: Evaluation of a new approach for modelling the screw–bone interface in a locking plate fixation: A corroboration study. Proc Inst Mech Eng H 2013,227(7):746–756.View ArticleGoogle Scholar
- Zhang QH, Tan SH, Chou SM: Effects of bone materials on the screw pull-out strength in human spine. Med Eng Phys 2006,28(8):795–801.View ArticleGoogle Scholar
- Chatzistergos PE, Magnissalis EA, Kourkoulis SK: A parametric study of cylindrical pedicle screw design implications on the pullout performance using an experimentally validated finite-element model. Med Eng Phys 2010,32(2):145–154.View ArticleGoogle Scholar
- Gao M, Lei W, Wu Z, Liu D, Shi L: 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.View ArticleGoogle Scholar
- Wu ZX, Lei W, Hu YY, Wang HQ, Wan SY, Ma ZS, Sang HX, Fu SC, Han YS: Effect of ovariectomy on BMD, micro-architecture and biomechanics of cortical and cancellous bones in a sheep model. Med Eng Phys 2008,30(9):1112–1118.View ArticleGoogle Scholar
- Yan YB, Qi W, Wang J, Liu LF, Teo EC, Tianxia Q, Ba JJ, Lei W: Relationship between architectural parameters and sample volume of human cancellous bone in micro-CT scanning. Med Eng Phys 2011,33(6):764–769.View ArticleGoogle Scholar
- Morgan EF, Bayraktar HH, Keaveny TM: Trabecular bone modulus–density relationships depend on anatomic site. J Biomech 2003,36(7):897–904.View ArticleGoogle Scholar
- Hou FJ, Lang SM, Hoshaw SJ, Reimann DA, Fyhrie DP: Human vertebral body apparent and hard tissue stiffness. J Biomech 1998,31(11):1009–1015.View ArticleGoogle Scholar
- Hashemi A, Bednar D, Ziada S: Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J 2009,9(5):404–410.View ArticleGoogle Scholar
- Chapman JR, Harrington RM, Lee KM, Anderson PA, Tencer AF, Kowalski D: Factors affecting the pullout strength of cancellous bone screws. J Biomech Eng 1996,118(3):391–398.View ArticleGoogle Scholar
- Grewal AS, Sabbaghian M: Load distribution between threads in threaded connections. J Press Vess-T Asme 1997,119(1):91–95.View ArticleGoogle Scholar
- Macdonald KA, Deans WF: Stress-analysis of drillstring threaded connections using the finite-element method. Eng Fail Anal 1995,2(1):1–30.View ArticleGoogle Scholar
- Hayes WC, Carter DR: Postyield behavior of subchondral trabecular bone. J Biomed Mater Res 1976,10(4):537–544.View ArticleGoogle Scholar
- Kopperdahl DL, Keaveny TM: Yield strain behavior of trabecular bone. J Biomech 1998,31(7):601–608.View ArticleGoogle Scholar
- McDonald K, Little J, Pearcy M, Adam C: Development of a multi-scale finite element model of the osteoporotic lumbar vertebral body for the investigation of apparent level vertebra mechanics and micro-level trabecular mechanics. Med Eng Phys 2010,32(6):653–661.View ArticleGoogle Scholar
- Mercer C, He MY, Wang R, Evans AG: Mechanisms governing the inelastic deformation of cortical bone and application to trabecular bone. Acta Biomater 2006,2(1):59–68.View ArticleGoogle Scholar
- Liu CL, Chen HH, Cheng CK, Kao HC, Lo WH: Biomechanical evaluation of a new anterior spinal implant. Clin Biomech (Bristol, Avon) 1998,13(1 Suppl 1):S40-S45.View ArticleGoogle Scholar
- Wu ZX, Gao MX, Sang HX, Ma ZS, Cui G, Zhang Y, Lei W: Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res 2012,173(1):91–98.View ArticleGoogle Scholar
- Jung MY, Shin DA, Hahn IB, Kim TG, Huh R, Chung SS: Serious complication of cement augmentation for damaged pilot hole. Yonsei Med J 2010,51(3):466–468.View ArticleGoogle Scholar
- Golz T, Graham CR, Busch LC, Wulf J, Winder RJ: Temperature elevation during simulated polymethylmethacrylate (PMMA) cranioplasty in a cadaver model. J Clin Neurosci 2010,17(5):617–622.View ArticleGoogle Scholar
- Gibson LJ: Biomechanics of cellular solids. J Biomech 2005,38(3):377–399.MathSciNetView ArticleGoogle Scholar
- Bayraktar HH, Morgan EF, Niebur GL, Morris GE, Wong EK, Keaveny TM: Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue. J Biomech 2004,37(1):27–35.View ArticleGoogle Scholar
- Zhang QH, Tan SH, Chou SM: Investigation of fixation screw pull-out strength on human spine. J Biomech 2004,37(4):479–485.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.