Use of awl for screw pilot hole creation increases strength of anterior cervical discectomy and fusion plate constructs in biomimetic model
Year: 2025
Type: article
Abstract: Background: Anterior cervical discectomy and fusion (ACDF) hardware failure can have serious complications for patients. Various advances in screw and plate design have increased the pullout strength of ACDF constructs, yet failure with screw pullout still occurs. One previously unexplored factor influencing pullout strength is the method of screw pilot hole creation. We aimed to compare pullout strength, stiffness, and strain of ACDF constructs in 3D-printed cervical spine vertebral bodies based on pilot hole creation with a drill versus an awl. Methods: Spine models were 3D-printed into uniform testing blocks to mimic cervical vertebrae, according to previously validated methods. Four pilot holes per block for eventual screw placement were made with a 3 mm drill (n = 20) or a 3mm awl (n = 20). Using a biomimetic model, a plate and four 3.5 mm screws were affixed to each testing block. Pullout strength, stiffness, and strain of the final construct were collected. Maximum axial pullout forces and forces over distance curves were recorded for statistical analysis. Results: Pullout strength of the construct was significantly greater in the awl group compared to the drill group (mean force during load-to-failure 810.8 N vs. 765.6 N, respectively; p = .002). No significant difference was observed in the stiffness (p = .434) or strain (p = .526) of the constructs based on method of pilot hole creation. Conclusions: This study aimed to evaluate the influence of pilot hole creation technique on biomechanical characteristics of ACDF constructs in a high fidelity 3D-printed biomimetic model. The results-favoring creation of pilot holes with an awl-highlight a biomechanical benefit of a previously unexplored surgical technique for the placement of ACDF screws. This may guide surgeons in choosing the optimal surgical technique to improve the strength of an ACDF construct, potentially minimizing complications and improving fusion rates.
Institution: Carolina Neurosurgery and Spine Associates
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4414420029