Assessment of Pedicle Bone Strength in the Lumbar Spine Using a “Smartâ€‌ Ball Tip Probe

Abstract

Preoperative assessment of bone mineral density (BMD) via dual Xray absorptiometry (DEXA) has been shown to help determine the need for screw augmentation, particularly in the pedicle. However, patients frequently present without preoperative DEXA scans, especially in trauma situations. We developed a “smartâ€‌ probe for intraoperative assessment of local bone strength in the pedicle. A standard ball tip probe was instrumented with an inline load cell and was used to test the bone strength of freshfrozen human cadaveric lumbar spine. Local bone crush strength was assessed using the probe at five locations within the centrum and the pedicle. The contralateral pedicle was outfitted with a standard pedicle screw and insertion torque and pullout force of the screw were measured. Correlation was found between PScentrum (probe strengthcentrum) and screw pullout strength (adj. R2 = 0.42). A stepwise linear regression revealed that when considering BMD, insertion torque, and PScentrum, pullout strength could be predicted based on PScentrum and insertion torque (adj. R2 = 0.51, p < 0.01, Fisher test). The results suggest that use of the new probe may be a more quantitative measurement of screw purchase when DEXA is unavailable, such as in spinal trauma cases. Furthermore, when used in conjunction with DEXA, the “smartâ€‌ ball tip probe may improve assessment of the strength of pedicle screw purchase.