Craniocaudal cyclic load improve risk assessment of lumbar pedicle screw loosening：finite element analysis based on computer tomography

Chenyu Jiang Hanqiang Ouyang Yali Li Ning Lang Yan Zhang Liang Jiang Huishu Yuan ^*

• Peking University Third Hospital, Haidian, China

Background: Pedicle screw loosening (PSL) is a frequent complication in osteoporotic patients undergoing spinal fixation, yet effective risk assessment methods are limited. This study explores the impact of craniocaudal cyclic load on pedicle screw fixation strength using computed tomography-based finite element analysis (CT-FEA) and evaluates its predictive value for PSL.Methods: A total of 23 PSL cases (7 men, 16 women) and 29 matched controls were analyzed using CT-FEA. Both simple axial pullout load and pullout load with preset craniocaudal cyclic load were applied to calculate pullout force. Hounsfield Unit (HU) values and volumetric bone mineral density (vBMD) of the screw trajectory were also assessed for osteoporosis evaluation. The pullout force and osteoporotic assessment value were compared between PSL and controls. Results: Craniocaudal cyclic loading significantly reduced pullout force (924.3±195.1 N vs. 745.2 ±188.7 N, p<0.0001). The PSL group had lower pullout force under cyclic load (629.6±188.2 N vs. 836.9±131.6 N, p<0.0001) and lower HU value of screw trajectories (183.7±42.6 vs. 206.7±29.72, p=0.026) compared to controls, while simple axial pullout force and vBMD showed no significant differences. Receiver operating characteristic (ROC) analysis indicated that pullout force under cyclic load (AUC = 0.806) was a better predictor of PSL than HU values (AUC = 0.629).Conclusions: This study demonstrates the critical role of craniocaudal cyclic loading in pedicle screw fixation strength and its predictive value for PSL. Craniocaudal cyclic load reduces screw fixation strength significantly. Pullout force under cyclic load assessed by CT-FEA enhances the predictive accuracy for PSL risk.