{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:04:46Z","timestamp":1760101486799,"version":"3.40.5"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Netherlands Organisation for Scientific Research","doi-asserted-by":"crossref","award":["17553"],"award-info":[{"award-number":["17553"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The success rate of spinal fusion surgery is mainly determined by the fixation strength of the spinal bone anchors. This study explores the use of an L-shaped spinal bone anchor that is intended to establish a macro-shape lock with the posterior cortical layer of the vertebral body, thereby increasing the pull-out resistance of the anchor. The performance of this L-shaped anchor was evaluated in lumbar vertebra phantoms (L1-L5) across four distinct perpendicular orientations (lateral, medial, superior, and inferior). During the pull-out experiments, the pull-out force, and the displacement of the anchor with respect to the vertebra was measured which allowed the determination of the maximal pull-out force (mean: 123 N \u00b1 25 N) and the initial pull-out force, the initial force required to start motion of the anchor (mean: 23 N \u00b1 16 N). Notably, the maximum pull-out force was observed when the anchor engaged the cortical bone layer. The results demonstrate the potential benefits of utilising a spinal bone anchor featuring a macro-shape lock with the cortical bone layer to increase the pull-out force. Combining the macro shape-lock fixation method with the conventional pedicle screw shows the potential to significantly enhance the fixation strength of spinal bone anchors.<\/jats:p>","DOI":"10.1371\/journal.pone.0302996","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T17:27:19Z","timestamp":1715189239000},"page":"e0302996","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing spinal bone anchor pull-out resistance with an L-shaped anchor"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5342-6721","authenticated-orcid":true,"given":"Esther Paula","family":"de Kater","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel Norbert","family":"Blom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teunis Cornelis","family":"van Doorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quoc Huy","family":"Tieu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Justin","family":"Jager","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4323-884X","authenticated-orcid":true,"given":"Aim\u00e9e","family":"Sakes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Breedveld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"pone.0302996.ref001","doi-asserted-by":"crossref","first-page":"126","DOI":"10.22603\/ssrr.2018-0055","article-title":"A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation","volume":"3","author":"VR Tukkapuram","year":"2019","journal-title":"Spine Surgery and Related Research"},{"key":"pone.0302996.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/00003086-198602000-00012","article-title":"A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine","volume":"203","author":"MR Zindrick","year":"1986","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"pone.0302996.ref003","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s005860100291","article-title":"Hydroxyapatite coating enhances fixation of loaded pedicle screws: a mechanical in vivo study in sheep","volume":"10","author":"B Sand\u00e9n","year":"2001","journal-title":"European Spine Journal"},{"key":"pone.0302996.ref004","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1097\/00007632-199711010-00007","article-title":"Structural Characteristics of the Pedicle and Its Role in Screw Stability","volume":"22","author":"T Hirano","year":"1997","journal-title":"Spine"},{"key":"pone.0302996.ref005","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00003086-199211000-00006","article-title":"Anatomic and Technical Considerations of Pedicle Screw Fixation","volume":"284","author":"JN Weinstein","year":"1992","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"pone.0302996.ref006","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00586-008-0715-9","article-title":"Delayed perforation of the aorta by a thoracic pedicle screw","volume":"17","author":"B Wegener","year":"2008","journal-title":"European Spine Journal"},{"key":"pone.0302996.ref007","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/00007632-200109150-00022","article-title":"Thoracic Pedicle Screw Fixation in Spinal Deformities: Are They Really Safe?","volume":"26","author":"S-I Suk","year":"2001","journal-title":"Spine"},{"key":"pone.0302996.ref008","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1097\/00007632-199408000-00016","article-title":"The effects of pedicle screw fit. 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