Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion

Abstract

Study design: An investigation of the relation between intraoperative insertional torque of pedicle screws, bone mineral density of the vertebra, and development of screw loosening in vivo.

Objectives: To determine the usefulness of intraoperative measurement of the insertional torque of pedicle screws.

Summary of background data: Some biomechanical studies have demonstrated that the insertional torque is highly correlated with bone mineral density and the stability of pedicle screws in vitro.

Methods: Pedicle screw fixation was performed with posterior lumbar interbody fusion in 62 consecutive patients. The mean age of the patients at the time of surgery was 58 years. The insertional torque of pedicle screws was measured intraoperatively in all patients. The mean follow-up period was 2.7 years.

Results: The mean insertional torque was 1.28 +/- 0.37 Nm in patients with screw loosening and 1.50 +/- 0. 40 Nm in patients without the problem. The mean insertional torque in patients with compression fractures in the upper vertebra adjacent to the fixed segment was 0.83 +/- 0.23 Nm. There was no significant difference between the mean insertional torque in patients with screw loosening and those without the condition. The mean insertional torque in patients without screw loosening was significantly greater than in patients with compression fractures (P < 0.01). A high correlation was found between insertional torque and bone mineral density (P < 0.01).

Conclusions: Although a high correlation was found between the insertional torque of pedicle screws and bone mineral density in vivo, the insertional torque could not objectively predict screw loosening.