Hole preparation techniques for transpedicle screws. Effect on pull-out strength from human cadaveric vertebrae.

In each of eight thoracolumbar human cadaveric vertebrae, a hole was made through one pedicle into the vertebral body with a drill bit and through the contralateral pedicle with a probe. Identical metal screws were implanted into the holes to equal depths, and maximum pull-out force was determined for each screw. Using a paired Student t test, no significant difference (P = 0.87) was found in pull-out strength between the screws implanted into drilled holes and those implanted into probed holes. In fact, the average pull-out strengths for the two groups differed by less than 2%. The pedicular cortex was broken through during hole preparation in 5 of the 16 pedicles: 3 as a result of drilling and 2 secondary to probing. The average pull-out strength of the screws in these five pedicles was 11.0% less than the average pull-out strength of the screws implanted into the contralateral intact pedicles. Although this does not represent a statistically significant difference (P = 0.15), it suggests that damaging the pedicular cortex may weaken pedicle screw fixation.