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Yamagishi A, Ishii M, Sakaura H, Yamasaki R, Ohnishi A, Tsukazaki H, Ohwada T, Ando W. The Influence of Titanium-coated Poryetheretherketone Cages in Fusion Status after Posterior Lumbar Interbody Fusion with Cortical Bone Trajectory Screw Fixation. World Neurosurg 2024; 183:e201-e209. [PMID: 38101540 DOI: 10.1016/j.wneu.2023.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Posterior lumbar interbody fusion (PLIF) with cortical bone trajectory (CBT) screw fixation (CBT-PLIF) shows potential for reducing adjacent segmental disease. Previously, our investigations revealed a relatively lower fusion rate with the use of carbon fiber-reinforced polyetheretherketone (CP) cages in CBT-PLIF compared with traditional pedicle screw fixation (PS-PLIF) using CP cages. This study aims to evaluate whether the implementation of titanium-coated polyetheretherketone (TP) cages can enhance fusion outcomes in CBT-PLIF. METHODS A retrospective analysis was conducted on 68 consecutive patients who underwent CBT-PLIF with TP cages (TP group) and 89 patients who underwent CBT-PLIF with CP cages (CP group). Fusion status was assessed using computed tomography at 1 year postoperatively and dynamic plain radiographs at 2 years postoperatively. RESULTS No statistically significant differences in fusion rates were observed at 1 and 2 years postoperatively between the TP group (86.8% and 89.7%, respectively) and the CP group (77.5% and 88.8%, respectively). Notably, the CP group exhibited a significant improvement in fusion rate from 1 to 2 years postoperatively (P = 0.002), while no significant improvement was observed in the TP group. CONCLUSIONS Examination of temporal changes in fusion rates reveals that only the TP group achieved a peak fusion rate 1 year postoperatively. This implies that TP cages may enhance the fusion process even after CBT-PLIF. Nevertheless, the definitive efficacy of TP cages for CBT-PLIF remains uncertain in the context of overall fusion rates.
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Affiliation(s)
- Akira Yamagishi
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
| | - Masayoshi Ishii
- Department of Orthopaedic Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Hironobu Sakaura
- Department of Orthopaedic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Ryoji Yamasaki
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Atsunori Ohnishi
- Department of Orthopaedic Surgery, Itami City Hospital, Itami, Hyogo, Japan
| | - Hiroyuki Tsukazaki
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tetsuo Ohwada
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
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Sevillano-Perez E, Prado-Novoa M, Postigo-Pozo S, Peña-Trabalon A, Guerado E. L4 fixation is not necessary in L5-Iliac spinopelvic fixation after trauma, but coadjutant transilio-transsacral fixation is. Injury 2024; 55:111378. [PMID: 38309085 DOI: 10.1016/j.injury.2024.111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Spinopelvic dissociation (SPD) is a severe injury characterized by a discontinuity between the spine and the bony pelvis consisting of a bilateral longitudinal sacral fracture, most of the times through sacral neuroforamen, and a horizontal fracture, usually through the S1 or S2 body. The introduction of the concept of triangular osteosynthesis has shown to be an advance in the stability of spinopelvic fixation (SPF). However, a controversy exists as to whether the spinal fixation should reach up to L4 and, if so, it should be combined with transiliac-transsacral screws (TTS). OBJECTIVE The purpose of this study is to compare the biomechanical behavior in the laboratory of four different osteosynthesis constructs for SPD, including spinopelvic fixation of L5 versus L4 and L5; along with or without TTS in both cases. MATERIAL AND METHODS By means of a formerly described method by the authors, an unstable standardized H-type sacral fracture in twenty synthetic replicas of a male pelvis articulated to the lumbar spine, L1 to sacrum, (Model: 1300, SawbonesTM; Pacific Research Laboratories, Vashon, WA, USA), instrumented with four different techniques, were mechanically tested. We made 4 different constructs in 5 specimen samples for each construct. Groups: Group 1. Instrumentation of the L5-Iliac bones with TTS. Group 2. Instrumentation of the L4-L5-Iliac bones with TTS. Group 3. Instrumentation of L5-Iliac bones without TTS. Group 4: Instrumentation of L4-L5-Iliac bones without TTS. RESULTS AND CONCLUSIONS According to our results, it can be concluded that in SPD, better stability is obtained when proximal fixation is only up to L5, without including L4 (alternative hypothesis), the addition of transiliac-transsacral fixations is essential.
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Affiliation(s)
| | - Maria Prado-Novoa
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Sergio Postigo-Pozo
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Alejandro Peña-Trabalon
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Enrique Guerado
- School of Medicine, University of Malaga, Malaga, Spain; Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, Marbella Malaga, Spain.
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Okamoto N, Okazaki R, Azuma S, Oshima Y. Clinical role of crosslink augmentation during short-segment posterior lumbar interbody fusion with total facetectomy: A propensity score-matched analysis. J Clin Neurosci 2024; 120:48-54. [PMID: 38185006 DOI: 10.1016/j.jocn.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/30/2023] [Indexed: 01/09/2024]
Abstract
We investigated the clinical role of crosslink augmentation during PLIF with total facetectomy. We retrospectively reviewed 376 patients who underwent one- or two-segment PLIF with unilateral or bilateral total facetectomy between January 2017 and March 2022. The patients were categorized into two groups based on whether a crosslink was instrumented or not. Radiological outcome measurements included fusion status and implant failure rates on 12-month postoperative computed tomography. Patient-reported outcome measures included the Numerical Rating Scale for lower back pain, Oswestry Disability Index, and Short Form-12 Physical Component Summary scores, which were assessed preoperatively and at 12 months postoperatively. Surgery-related complications included surgical site infection, symptomatic implant failure, and epidural hematoma. Propensity score matching was performed to compare both groups after adjusting for confounding factors, including baseline and surgical procedural characteristics. A total of 200 cases were included in the propensity score calculation, and one-to-one matching was performed, resulting in 56 pairs with and without a crosslink. The fusion status (88.7 % vs. 85.5 %), screw loosening (14.3 % vs. 14.3 %), cage subsidence (17.9 % vs. 16.1 %), and cage dislodgement (5.4 % vs. 0 %) showed no significant difference between those with and without a crosslink, respectively. No significant differences were observed in the patient-reported outcomes or surgery-related complication rates between the groups. Crosslink augmentation during PLIF with total facetectomy is not recommended because it does not provide any radiological or clinical benefit and is associated with avoidable expenses.
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Affiliation(s)
- Naoki Okamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan 1-5 Shintoshin, Chuo-ku, Saitama 330-0081, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
| | - Rentaro Okazaki
- Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan 1-5 Shintoshin, Chuo-ku, Saitama 330-0081, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Seiichi Azuma
- Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan 1-5 Shintoshin, Chuo-ku, Saitama 330-0081, Japan; University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Yasushi Oshima
- University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
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Han Y, Ren X, Liang Y, Ma X, Wang X. Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis. J Orthop Surg Res 2023; 18:484. [PMID: 37408002 DOI: 10.1186/s13018-023-03977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The influence of total en bloc spondylectomy (TES) on spinal stability is substantial, necessitating strong fixation to restore spinal stability. The transverse connector (TC) serves as a posterior spinal instrumentation that connects the left and right sides of the pedicle screw-rod system. Several studies have highlighted the potential of a TC in enhancing the stability of the fixed segments. However, contradictory results have suggested that a TC not only fails to improve the stability of the fixed segments but also might promote stress associated with internal fixation. To date, there is a lack of previous research investigating the biomechanical effects of a TC on TES. This study aimed to investigate the biomechanical effects of a TC on internal fixation during TES of the lumbar (L) spine. METHODS A single-segment (L3 segment) TES was simulated using a comprehensive L spine finite element model. Five models were constructed based on the various positions of the TC, namely the intact model (L1-sacrum), the TES model without a TC, the TES model with a TC at L1-2, the TES model with a TC at L2-4, and the TES model with a TC at L4-5. Mechanical analysis of these distinct models was conducted using the Abaqus software to assess the variations in the biomechanics of the pedicle screw-rod system, titanium cage, and adjacent endplates. RESULTS The stability of the surgical segments was found to be satisfactory across all models. Compared with the complete model, the internal fixation device exhibited the greatest constraint on overextension (95.2-95.6%), while showing the least limitation on left/right rotation (53.62-55.64%). The application of the TC had minimal effect on the stability of the fixed segments, resulting in a maximum reduction in segment mobility of 0.11° and a variation range of 3.29%. Regardless of the use of a TC, no significant changes in stress were observed for the titanium cage. In the model without the TC, the maximum von Mises stress (VMS) for the pedicle screw-rod system reached 136.9 MPa during anterior flexion. Upon the addition of a TC, the maximum VMS of the pedicle screw-rod system increased to varying degrees. The highest recorded VMS was 459.3 MPa, indicating a stress increase of 335.5%. Following the TC implantation, the stress on the adjacent endplate exhibited a partial reduction, with the maximum stress reduced by 27.6%. CONCLUSION The use of a TC in TES does not improve the stability of the fixed segments and instead might result in increased stress concentration within the internal fixation devices. Based on these findings, the routine utilisation of TC in TES is deemed unnecessary.
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Affiliation(s)
- Ye Han
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No. 212, Yuhua Road, Hebei, Baoding City, 071000, China
| | - Xuehong Ren
- Hebei University, Hebei, Baoding City, China
| | - Yijie Liang
- Hebei University, Hebei, Baoding City, China
| | - Xiaoyong Ma
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No. 212, Yuhua Road, Hebei, Baoding City, 071000, China
| | - Xiaodong Wang
- Department of Orthopaedics, Affiliated Hospital of Hebei University, No. 212, Yuhua Road, Hebei, Baoding City, 071000, China.
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Is it a requirement or a preference to use cross-links in lumbar instrumentation? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background/Aim: The use of cross-links (CL) is controversial due to reasons such as cost increases and instrument redundancy. While there are many biomechanical studies, the clinical data is limited. The aim of this study is to present the clinical effects of CL by putting forward postoperative clinical outcomes and long-term results of patients with (CL+) and without (CL-) CL augmentation.
Methods: In this retrospective cohort study, patients who underwent lumbar posterior instrumentation with CL+ (n = 164) and without CL- (n = 111) augmentation were evaluated. Demographic data, surgical results, preoperative and postoperative visual analogue scale (VAS), the Oswestry Disability Index (ODI) differences, and pseudoarthrosis and adjacent segment disease (ASD)-related recurrence for more than three years of follow-up were determined. Data of CL+ and CL- groups were compared.
Results: CL+ and CL- groups were similar in terms of age and gender (P = 0.319 and P = 0.777, respectively) There was no difference between the two groups in terms of bleeding amount, duration of surgery, and duration of hospitalization (P = 0.931, P = 0.669 and P = 0.518, respectively). Groups were similar in terms of VAS and ODI differences (P = 0.915 and P = 0.983, respectively), yet there was one case of infection in the CL+ group and two cases of infection detected in the CL- group. There were 13 ASDs in the CL+ group, and eight ASDs in the CL- group. Pseudoarthrosis was seen seven times in the CL+ group, while it was four in the CL- group.
Conclusion: It was observed that adding CL in patients who underwent lumbar instrumentation did not change the early period surgical results. The prevalence of complications was compatible with the scientific literature. In our study, there was no preventive advantage in terms of clinical or postoperative complications found in the use of CL.
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Han L, Yang H, Li Y, Li Z, Ma H, Wang C, Yuan J, Zheng L, Chen Q, Lu X. Biomechanical Evaluation of the Cross-link Usage and Position in the Single and Multiple Segment Posterior Lumbar Interbody Fusion. Orthop Surg 2022; 14:2711-2720. [PMID: 36102202 PMCID: PMC9531066 DOI: 10.1111/os.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Previous studies have neither explored the usage of cross-links nor investigated the optimal position of the cross-links in posterior lumbar interbody fusion (PLIF). This study evaluates biomechanical properties of cross-links in terms of different fixation segments and optimal position in single- and multi-segment posterior lumbar interbody fusion. METHODS Two finite element (FE) models of instrumented lumbosacral spine with single-(L4/5) and multi-segment (L3-S1) PLIF surgery were simulated. On the basis of the two models, the benefits of the usage of cross-links were assessed and compared with the status of no application of cross-links. Moreover, the effects of position of cross-links on multi-segment PLIF surgery were studied in Upper, Middle, and Lower positions. RESULTS No significant difference was found in the range of motion (ROM), intersegmental rotational angle (IRA) of adjacent segments, and intradiscal pressure (IDP) regardless of the usage of cross-links in the single-segment PLIF surgery, while the cross-link increased the maximum von Mises stress in the fixation (MSF) under the axial rotation (53.65 MPa vs 41.42 MPa). In the multi-segment PLIF surgery, the usage of cross-links showed anti-rotational advantages indicated by ROM (Without Cross-link 2.35o , Upper, 2.24o ; Middle, 2.26o ; Lower, 2.30o ) and IRA (Without Cross-link 1.19o , Upper, 1.08o ; Middle, 1.09o ; Lower, 1.13o ). The greatest values of MSF were found in without cross-link case under the flexion, lateral bending, and axial rotation (37.48, 62.61, and 86.73 MPa). The application of cross-links at the Middle and Lower positions had lower values of MSF (48.79 and 69.62 MPa) under the lateral bending and axial rotation, respectively. CONCLUSION The application of cross-links was not beneficial for the single-segment PLIF, while it was found highly advantageous for the multi-segment PLIF. Moreover, the usage of cross-links at the Middle or Lower positions resulted in a better biomechanical stability.
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Affiliation(s)
- Lin Han
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
| | - Haisong Yang
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
| | - Yongheng Li
- Biomechanics LaboratorySchool of Biological Science & Medical Engineering, Southeast UniversityNanjingChina
| | - Zhiyong Li
- Biomechanics LaboratorySchool of Biological Science & Medical Engineering, Southeast UniversityNanjingChina,School of Mechanical Medical and Process Engineering, Queensland University of TechnologyBrisbaneAustralia
| | - Hongdao Ma
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
| | - Chenfeng Wang
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
| | - Jincan Yuan
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
| | - Luyu Zheng
- School of Medicine, Zhengzhou UniversityZhengzhouChina
| | - Qiang Chen
- Biomechanics LaboratorySchool of Biological Science & Medical Engineering, Southeast UniversityNanjingChina
| | - Xuhua Lu
- Department of OrthopaedicsShanghai Changzheng Hospital, Second Military Medical UniversityShanghaiChina
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The biomechanical fundamentals of crosslink-augmentation in posterior spinal instrumentation. Sci Rep 2022; 12:7621. [PMID: 35538122 PMCID: PMC9090827 DOI: 10.1038/s41598-022-11719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Posterior screw-rod constructs can be used to stabilize spinal segments; however, the stiffness is not absolute, and some motion can persist. While the effect of crosslink-augmentation has been evaluated in multiple studies, the fundamental explanation of their effectiveness has not been investigated. The aim of this study was to quantify the parameters “screw rotation” and “parallelogram deformation” in posterior instrumentations with and without crosslinks to analyze and explain their fundamental effect. Biomechanical testing of 15 posteriorly instrumented human spinal segments (Th10/11—L4/L5) was conducted in axial rotation, lateral bending, and flexion–extension with ± 7.5 Nm. Screw rotation and parallelogram deformation were compared for both configurations. Parallelogram deformation occurred predominantly during axial rotation (2.6°) and was reduced by 60% (−1.45°, p = 0.02) by the addition of a crosslink. Simultaneously, screw rotation (0.56°) was reduced by 48% (−0.27°, p = 0.02) in this loading condition. During lateral bending, 0.38° of parallelogram deformation and 1.44° of screw rotation was measured and no significant reduction was achieved by crosslink-augmentation (8%, −0.03°, −p = 0.3 and −13%, −0.19°, p = 0.7 respectively). During flexion–extension, parallelogram deformation was 0.4° and screw rotation was 0.39° and crosslink-augmentation had no significant effect on these values (−0.12°, −30%, p = 0.5 and −0°, −0%, p = 0.8 respectively). In axial rotation, crosslink-augmentation can reduce parallelogram deformation and with that, screw rotation. In lateral bending and flexion–extension parallelogram deformation is minimal and crosslink-augmentation has no significant effect. Since the relatively large screw rotation in lateral bending is not caused by parallelogram deformation, crosslink-augmentation is no adequate countermeasure. The fundamental understanding of the biomechanical effect of crosslink-augmentation helps better understand its potential and limitations in increasing construct stiffness.
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Mirzaei F, Iranmehr A, Shokouhi G, Khadivi M, Shakeri M, Namvar M, Rafiei E, Matloubi B. The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:105-110. [PMID: 35526942 DOI: 10.1016/j.neucie.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER IRCT20120527009878N3.
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Affiliation(s)
- Farhad Mirzaei
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghaffar Shokouhi
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Khadivi
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Moslem Shakeri
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamad Namvar
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ebrahim Rafiei
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bagher Matloubi
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
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Burkhard MD, Cornaz F, Spirig JM, Wanivenhaus F, Loucas R, Fasser MR, Widmer J, Farshad M. Posterior spinal instrumentation and decompression with or without cross-link? NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 8:100093. [PMID: 35141657 PMCID: PMC8820010 DOI: 10.1016/j.xnsj.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Background Posterior lumbar instrumentation requires sufficient primary stiffness to ensure bony fusion and to avoid pseudarthrosis, screw loosening, or implant failure. To enhance primary construct stiffness, transverse cross-link (CL) connectors attached to the vertical rods can be used. Their effect on the stability of a spinal instrumentation with simultaneous decompression is yet not clear. This study aimed to evaluate the impact of CL augmentation on single-level lumbar instrumentation stiffness after gradual decompression procedures. Methods Seventeen vertebral segments (6 L1/2, 6 L3/4, 5 L5/S1) of 12 fresh-frozen human cadavers were instrumented with a transpedicular screw–rod construct following the traditional pedicle screw trajectory. Range of motion (ROM) of the segments was sequentially recorded before and after four procedures: (A) instrumented before decompression, (B) instrumented after unilateral laminotomy, (C) instrumented after midline bilateral laminotomy, and (D) instrumented after unilateral facetectomy (with transforaminal lumbar interbody fusion [TLIF]). Each test was performed with and without CL augmentation. The motion between the cranial and caudal vertebrae was evaluated in all six major loading directions: flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression/distraction (AC). Results ROM was significantly reduced with CL augmentation in AR by Δ0.03–0.18° (7–12%) with a significantly higher ROM reduction after more extensive decompression. Furthermore, slight reductions in FE and LB were observed; these reached statistical significance for FE after facetectomy and TLIF insertion only (Δ0.15; 3%). The instrumentation levels did not reveal any subgroup differences. Conclusion CL augmentation reduces AR-ROM by 7–12% in single-level instrumentation of the lumbar spine, with the effect increasing along with the extensiveness of the decompression technique. In light of the discrete absolute changes, CL augmentation may be warranted for highly unstable vertebral segments rather than for standard single-level posterior spinal fusion and decompression.
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Affiliation(s)
- Marco D. Burkhard
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- Corresponding author.
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - José Miguel Spirig
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Florian Wanivenhaus
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute for Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jonas Widmer
- Institute for Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
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Mirzaei F, Iranmehr A, Shokouhi G, Khadivi M, Shakeri M, Namvar M, Rafiei E, Matloubi B. The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00011-7. [PMID: 33676794 DOI: 10.1016/j.neucir.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER IRCT20120527009878N3.
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Affiliation(s)
- Farhad Mirzaei
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghaffar Shokouhi
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Khadivi
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Moslem Shakeri
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamad Namvar
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ebrahim Rafiei
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bagher Matloubi
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
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Cornaz F, Widmer J, Snedeker JG, Spirig JM, Farshad M. Cross-links in posterior pedicle screw-rod instrumentation of the spine: a systematic review on mechanical, biomechanical, numerical and clinical studies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:34-49. [DOI: 10.1007/s00586-020-06597-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/13/2020] [Accepted: 09/05/2020] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
Dorsal screw-rod instrumentations are used for a variety of spinal disorders. Cross-links (CL) can be added to such constructs, however, no clear recommendations exist. This study aims to provide an overview of the available evidence on the effectiveness of CL, potentially allowing to formulate recommendations on their use.
Methods
A systematic literature review was performed on PubMed and 37 original articles were included and grouped into mechanical, biomechanical, finite element and clinical studies. The change in range of motion (ROM) was analyzed in mechanical and biomechanical studies, ROM, stiffness and stress distribution were evaluated in finite element studies and clinical outcome parameters were analyzed in clinical studies.
Results
A relative consistent reduction in ROM in axial rotation with CL-augmentation was reported, while minor and less consistent effects were observed in flexion–extension and lateral bending. The use of CLs was clinical beneficial in C1/2 fusion, while the limited clinical studies on other anatomic regions show no significant benefit for CL-augmentation.
Conclusion
While CL provides some additional axial rotation stability in most situations, lateral bending and flexion–extension are less affected. Based on clinical data, CL-augmentation can only be recommended for C1/2 instrumentations, while for other cases, further clinical studies are needed to allow for evidence-based recommendations.
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Hong JB, Son DM, Park TH, Woo SH, Lee SJ, Choi UY, Han IB, Chung CK, Kim YJ, Sohn S. Risk of rod fracture according to cross-link position in pedicle subtraction osteotomy (PSO): A finite element study. J Clin Neurosci 2020; 73:304-307. [DOI: 10.1016/j.jocn.2020.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
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Wang HW, Yin YH, Li T, Yu XG, Qiao GY. Effects of transverse connector on reduction and fixation of atlantoaxial dislocation and basilar invagination using posterior C1-C2 screw-rod technique. Spine J 2019; 19:1995-2002. [PMID: 31254651 DOI: 10.1016/j.spinee.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The mechanical strength provided by internal fixation is crucial for maintaining reduction and facilitating bony fusion. Though satisfactory results with the C1-C2 technique have been acquired in most clinical reports, the related problems of fusion delay and pseudarthrosis still exist. To increase the chance of bony fusion, a transverse connector (TC) is frequently used to augment torsional stiffness of thoracolumbar screw/rod constructs. Nevertheless, the clinical implication of TC in the management of atlantoaxial dislocation (AAD) and basilar invagination (BI) remains largely unknown. PURPOSE To evaluate the effects of TC application on C1-C2 screw-rod constructs based on consecutive adult patients with AAD and BI in a single institution over a 10-year period. STUDY DESIGN A retrospective study. PATIENT SAMPLE Patients with AAD and BI, who were treated with posterior C1-C2 screw-rod technique with or without TC usage from June 2007 to June 2017 at a single institution. OUTCOME MEASURES The radiological measurements included the anterior atlantodental interval (AADI), posterior atlantodental interval (PADI), height of odontoid process above Chamberlain line, and cervicomedullary angle (CMA). Patients' neurologic status was evaluated with the Japanese Orthopaedic Association (JOA) score. Fusion status was evaluated at different follow-up periods. METHODS We compared the difference of clinical, radiological, and surgical outcomes between the TC and NTC groups postoperatively. RESULTS In total, there were 149 consecutive patients in the TC group and 168 patients in the NTC group. On average, 1.2 TCs per patient were used in the TC group. No significant differences were identified for operative time and blood loss between groups. There was also no statistical difference in the radiological measurements of AADI, PADI, Chamberlain line, and CMA between the TC and NTC groups preoperatively and postoperatively. A significantly higher JOA score was obtained in the TC group than that in the NTC group postoperatively. The fusion rates were higher in the TC group than those in the NCT group at the early stage postoperatively (3 and 6 months; p<.01). CONCLUSIONS Use of TCs seems to improve bony fusion and neurologic outcomes in the treatment of AAD and BI with C1-C2 screw-rod technique.
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Affiliation(s)
- Hua-Wei Wang
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China
| | - Yi-Heng Yin
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China
| | - Teng Li
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China
| | - Xin-Guang Yu
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China.
| | - Guang-Yu Qiao
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing 100853, China
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Abstract
STUDY DESIGN Retrospective review of a multicenter, prospective database. OBJECTIVE Our aim was to compare complication rates and maintenance of radiographic correction at 2 years after posterior spinal fusion (PSF) with or without cross-links in patients with cerebral palsy (CP)-related scoliosis. SUMMARY OF BACKGROUND DATA Cross-links are frequently used in PSF to correct scoliosis in patients with CP because they are thought to increase the stiffness and torsional rigidity of the construct. METHODS We reviewed the records of patients with CP who underwent primary PSF with or without cross-links between August 2008 and April 2015. Inclusion criteria were minimum follow-up of 2 years, availability of complications data (implant failure, surgical site infection, revision), and pre- and postoperative measurements of the major curve (measured using the Cobb method). The 256 patients included in this analysis had a mean age of 14.1 ± 2.7 years. Ninety-four patients had cross-links (57% using one cross-link; 43% using two cross-links) and 162 patients did not have cross-links. P < 0.05 was considered statistically significant. RESULTS The two groups did not differ significantly with regard to sex, age at surgery, preoperative menarche status, Gross Motor Function Classification System level, major curve magnitude, pelvic obliquity, kyphosis, and lordosis angles. There were no significant differences between groups in the correction achieved or the maintenance of correction at 2 years for the major curve, pelvic obliquity, kyphosis, or lordosis (all P > 0.05). Complication rates were similar between the cross-link group (16%, N = 15) and the non-cross-link group (14%, N = 22). CONCLUSION At 2 years after PSF to treat CP-related scoliosis, patients had no significant differences in the degree of correction achieved, the maintenance of correction, or the rate of complications between those whose fusion constructs used cross-links and those whose constructs did not. LEVEL OF EVIDENCE 3.
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Clin J, Le Navéaux F, Driscoll M, Mac-Thiong JM, Labelle H, Parent S, Shah SA, Lonner BS, Newton PO, Serhan H. Biomechanical Comparison of the Load-Sharing Capacity of High and Low Implant Density Constructs With Three Types of Pedicle Screws for the Instrumentation of Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:2-10. [PMID: 30587316 DOI: 10.1016/j.jspd.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Biomechanical numerical simulation analysis of implant design and density in adolescent idiopathic scoliosis posterior instrumentation. OBJECTIVES To evaluate the combined effect of pedicle screw design and density on deformity correction and construct load-sharing capacity. SUMMARY OF BACKGROUND DATA Screw density is an area of popular study because of the impact of cost and potential patient morbidity of higher-density constructs. Using fewer screws raises concern about reduced correction and greater forces on each screw. METHODS Personalized spinal numerical models were created for five patients. The correction techniques from five spine surgeons using both a high- and a low-density implant pattern (2 vs. 1.4 ± 0.22 screws/level) with uniaxial, multiaxial, and favored angle screws were simulated. The predicted correction and forces sustained by the implants were compared. The postoperative load-sharing capacity of a high- and a low-density construct, with or without crosslinks, was compared by simulating daily activities motions. RESULTS The major coronal curve correction was similar with high- and low-density constructs (73% ± 10% vs. 72% ± 10%; p > .05) but was higher when using uniaxial (77% ± 8%) compared to multiaxial (69% ± 11%) and favored angle screws (71% ± 10%; p = .009). High- and low-density constructs sustained similar intraoperative peak forces (305 ± 61 N vs. 301 ± 73 N; p = .23) regardless of screw design (all p > .05). Multiaxial and favored angle screws reduced the peak axial force by 23% and 38% compared to uniaxial screws (p = .007). The high-density construct reduced the postoperative loads sustained by each implant by 31% (p = .006). Crosslinks had no effect on load sharing (p = .23). CONCLUSION High- and low-density implant patterns achieved similar coronal correction with equivalent capacity to share corrective forces regardless of the screw design. Increased degrees of freedom of the screw head reduces the capacity to correct coronal deformity but generates lower bone-screw forces. The reduced number of screws increased the postoperative forces sustained by each screw, but its effect on potential complications requires further investigations. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Julien Clin
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada
| | - Franck Le Navéaux
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada.
| | - Mark Driscoll
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada
| | - Jean-Marc Mac-Thiong
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada
| | - Hubert Labelle
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada
| | - Stefan Parent
- Spinologics, Inc., 6750 Avenue de l'Esplanade #290, Montréal, Quebec, H2V 1A2, Canada
| | - Suken A Shah
- Nemours Alfred I. Dupont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Baron S Lonner
- Mount Sinai Hospital, E 101st St, New York, NY 10029, USA
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Hassan Serhan
- DePuy Synthes Spine Inc., 325 Paramount Drive, Raynham, MA 02767, USA
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Wang T, Cai Z, Zhao Y, Wang W, Zheng G, Wang Z, Wang Y. The Influence of Cross-Links on Long-Segment Instrumentation Following Spinal Osteotomy: A Finite Element Analysis. World Neurosurg 2018; 123:e294-e302. [PMID: 30496922 DOI: 10.1016/j.wneu.2018.11.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop finite element models of spine following osteotomy and evaluate the effect of number and location of cross-links (CLs) on long-segment instrumentation. METHODS A finite element model of instrumented spine following osteotomy was created from computed tomography images of a postoperative male patient with thoracolumbar kyphotic deformity. Five fixation models were established to simulate different number and location of CLs. Four loading conditions (flexion, extension, lateral bending, and axial rotation) were applied on the models. Range of motion (ROM), maximum value and distribution of stress on implants, and stress on vertebrae were compared between models. RESULTS With increased number of CLs, average ROM of instrumented segments was reduced by 2.37%, 1.89%, and 2.49% in flexion, extension, and lateral bending. ROM was reduced by 21.98% in loading axial rotation condition. With increased number of CLs, ROM tended to be limited. Peak stresses were located on rods during axial rotation, on proximal pedicle screws during flexion, and on the osteotomy site during extension and lateral bending. CLs had an effect of dispersing stress concentration. CONCLUSIONS The application of CLs enhanced the rigidity of the construct. With increased number of CLs, ROM of the construct was decreased, especially in axial rotation. CLs can also disperse the stress concentration. After comparing various CL configurations in different motion conditions, we believe that the optimal method is to place 2 CLs at the osteotomy site and the proximal segment.
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Affiliation(s)
- Tianhao Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China; Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Zhihua Cai
- School of Electromechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Yongfei Zhao
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Wei Wang
- School of Electromechanical Engineering, Hunan University of Science and Technology, Xiangtan, China
| | - Guoquan Zheng
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Zheng Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Yan Wang
- Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing, China.
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Shen K, Tan Z, Yang F, Zhang S, Cao D. [Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:677-682. [PMID: 29798648 PMCID: PMC8498298 DOI: 10.7507/1002-1892.201701092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/18/2017] [Indexed: 11/03/2022]
Abstract
Objective To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Methods A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups ( P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated. Results All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group ( P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups. Conclusion Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.
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Affiliation(s)
- Kai Shen
- Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013, P.R.China
| | - Zujian Tan
- Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013,
| | - Fubin Yang
- Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013, P.R.China
| | - Shengli Zhang
- Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013, P.R.China
| | - Daigui Cao
- Department of Spine Surgery, Chongqing General Hospital, Chongqing, 400013, P.R.China
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Luo M, Shen M, Wang W, Xia L. Comparison of Consecutive, Interval, and Skipped Pedicle Screw Techniques in Moderate Lenke Type 1 Adolescent Idiopathic Scoliosis. World Neurosurg 2016; 98:563-570. [PMID: 27888080 DOI: 10.1016/j.wneu.2016.11.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare perioperative, radiographic, and Scoliosis Research Society-22 (SRS-22) outcomes of consecutive, interval, and skipped pedicle screw techniques in patients with moderate Lenke type 1 adolescent idiopathic scoliosis (AIS). METHODS We retrospectively reviewed 65 consecutive moderate Lenke type 1 AIS patients at a single institution using all-pedicle screw constructs, with a minimum of 2 years of follow-up. In the consecutive group (C group, n = 22), pedicle screws were instrumented at consecutive levels bilaterally. In the interval group (I group, n = 18), pedicle screws were placed at every level on the concave side while skipping levels on the convex side. In the skipped group (S group, n = 25), pedicle screws were instrumented by skipping levels bilaterally. Perioperative, radiographic, and SRS-22 measurements were analyzed with a 1-way analysis of variance. RESULTS No significant differences were found in length of hospital stay, fused levels, coronal correction, and SRS-22 scores among the 3 groups. Increased surgery time was found in the C group compared with the I and S groups (P = 0.001 and P = 0.005, respectively). Decreased blood loss and blood transfusions were found in the S group compared with the C group (P = 0.04 and P = 0.047, respectively). Decreased implant costs were found in the S group compared with the C and I groups (P < 0.001 and P = 0.03, respectively). CONCLUSIONS Consecutive, interval, and skipped pedicle screw techniques all provide satisfactory deformity correction and SRS-22 outcomes with few complications. With better perioperative outcomes, interval and skipped pedicle screw techniques are the more cost-effective options for patients with moderate Lenke type 1 AIS.
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Affiliation(s)
- Ming Luo
- Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Mingkui Shen
- Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Wengang Wang
- Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Lei Xia
- Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China.
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