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Steinmetz MP, Riggleman JR, Mahoney JM, Harris JA, Butler JB, Ferrick BJ, Bucklen BS. A Dual-Screw Technique for Vertebral Compression Fractures via Robotic Navigation in the Osteopenic Lumbar Spine: An In-Vitro Biomechanical Analysis. Global Spine J 2024; 14:1706-1713. [PMID: 36644787 PMCID: PMC11268308 DOI: 10.1177/21925682231152833] [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] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Biomechanical cadaveric study. OBJECTIVES Multi-rod constructs maximize posterior fixation, but most use a single pedicle screw (PS) anchor point to support multiple rods. Robotic navigation allows for insertion of PS and cortical screw (CS) within the same pedicle, providing 4 points of bony fixation per vertebra. Recent studies demonstrated radiographic feasibility for dual-screw constructs for posterior lumbar spinal fixation; however, biomechanical characterization of this technique is lacking. METHODS Fourteen cadaveric lumbar specimens (L1-L5) were divided into 2 groups (n = 7): PS, and PS + CS. VCF was simulated at L3. Bilateral posterior screws were placed from L2-L4. Load control (±7.5Nm) testing performed in flexion-extension (FE), lateral bending (LB), axial rotation (AR) to measure ROM of: (1) intact; (2) 2-rod construct; (3) 4-rod construct. Static compression testing of 4-rod construct performed at 5 mm/min to measure failure load, axial stiffness. RESULTS Four-rod construct was more rigid than 2-rod in FE (P < .001), LB (P < .001), AR (P < .001). Screw technique had no significant effect on FE (P = .516), LB (P = .477), or AR (P = .452). PS + CS 4-rod construct was significantly more stable than PS group (P = .032). Stiffness of PS + CS group (445.8 ± 79.3 N/mm) was significantly greater (P = .019) than PS (317.8 ± 79.8 N/mm). Similarly, failure load of PS + CS group (1824.9 ± 352.2 N) was significantly greater (P = .001) than PS (913.4 ± 309.8 N). CONCLUSIONS Dual-screw, 4-rod construct may be more stable than traditional rod-to-rod connectors, especially in axial rotation. Axial stiffness and ultimate strength of 4-rod, dual-screw construct were significantly greater than rod-to-rod. In this study, 4-rod construct was found to have potential biomechanical benefits of increased strength, stiffness, stability.
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Affiliation(s)
- Michael P. Steinmetz
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Center for Spine Health Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jessica R. Riggleman
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA, USA
| | - Jonathan M. Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA, USA
| | - Jonathan A. Harris
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA, USA
| | - John B. Butler
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Center for Spine Health Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bryan J. Ferrick
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA, USA
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Han Y, Ma J, Zhang G, Huang L, Kang H. Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study. J Orthop Surg Res 2024; 19:85. [PMID: 38254136 PMCID: PMC10801944 DOI: 10.1186/s13018-024-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment. METHODS A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group. RESULTS The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage). CONCLUSIONS Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.
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Affiliation(s)
- Yaozheng Han
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Ma
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Guoquan Zhang
- Medical College, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Liangliang Huang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
| | - Hui Kang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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Sourani A, Rezvani M, Asadi J, Foroughi M, Tehrani DS. Authors' Reply to Letter to the Editor: Commentary on In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes ( Korean J Neurotrauma 2023;19:90-102). Korean J Neurotrauma 2023; 19:509-510. [PMID: 38222841 PMCID: PMC10782105 DOI: 10.13004/kjnt.2023.19.e58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Arman Sourani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamalodin Asadi
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Foroughi
- Isfahan Medical Students’ Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Donya Sheibani Tehrani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Chhabra HS, Yelamarthy PKK, Moolya SN, Erli HJ, Theron F, Abel R, Haak M, Tuli S, Yadav SL, Hoque MF. Development and validation of a simplified thoracolumbar spine fracture classification system. Spinal Cord 2021; 59:1268-1277. [PMID: 34580417 DOI: 10.1038/s41393-021-00706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Development and validation of fracture classification system. OBJECTIVE To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures). SETTING Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. RESULTS In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. CONCLUSIONS The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.
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Affiliation(s)
- Harvinder Singh Chhabra
- Chief of Spine Services & Medical Director, Indian Spinal Injuries Center Sector - C, Vasant Kunj, New Delhi, India.
| | | | | | - Hans Josef Erli
- Ret. Director of the Department of Spine Surgery, Vivantes Humboldt Hospital, Berlin, Germany
| | - Francois Theron
- Lecturer in Orthopedics, University of Pretoria, Pretoria, South Africa
| | - Rainer Abel
- Doctor of Medicine, Klinikum Bayreuth GmbH, Orthopedic Surgery, Bayreuth, Germany
| | - Michael Haak
- Chief, Orthopaedic Spine Surgery, Director, Orthopaedic Spine Fellowship, Geisinger Health System, Danville, PA, USA
| | - Sagun Tuli
- Spine Neurosurgeon, Head Florida Spinal Surgery Center, Miami, FL, USA
| | - S L Yadav
- Department of Physical Medicine & Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Md Fazlul Hoque
- Senior Consultant Orthopaedic and Spinal Surgery Square Hospitals Ltd, Dhaka, Bangladesh
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Selection of the fusion and fixation range in the intervertebral surgery to correct thoracolumbar and lumbar tuberculosis: a retrospective clinical study. BMC Musculoskelet Disord 2021; 22:466. [PMID: 34020626 PMCID: PMC8140488 DOI: 10.1186/s12891-021-04335-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare the diseased verses the non-diseased intervertebral surgery used in the treatment of thoracolumbar and lumbar spinal tuberculosis and to explore the best choice of fusion of fixation range. Methods Two hundred twenty-one patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. One hundred eighteen patients underwent the diseased intervertebral surgery (lesion vertebral pedicle fixation, Group A) and 103 patients underwent the non-diseased intervertebral surgery (1 or 2 vertebral fixation above and below the affected vertebra, group B). Spinal tuberculosis diagnosis was confirmed in both groups of patients before lesion removal, bone graft fusion, and internal fixation. Clinical data and efficacy of the two surgical methods were then evaluated. Results The mean follow-up duration for both procedures was 65 months (50–68 months range). There were no significant differences in laboratory examinations, VAS scores, and the Cobb angle correction rate and the angle loss. However, significant differences existed in the operation time, blood loss, serosanguineous drainage volume, and blood transfusion requirement between the two groups. The diseased intervertebral surgery group performed significantly better than the non-diseased intervertebral surgery group in all of these areas. In both cases, the bone graft fused completely with the normal bone by the last follow-up, occuring at 50–86 months post surgery. Conclusion The diseased intervertebral surgery is a safe and feasible option for the treatment of thoracolumbar and lumbar tuberculosis. It effectively restores the physiological curvature of the spine and reduces the degeneration of adjacent vertebral bodies in the spinal column.
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Current status of short segment fixation in thoracolumbar spine injuries. J Clin Orthop Trauma 2020; 11:770-777. [PMID: 32879564 PMCID: PMC7452221 DOI: 10.1016/j.jcot.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/20/2022] Open
Abstract
Short segment fixation aims to restore spinal stability and alignment in thoracolumbar spine injuries while preserving spinal motion by decreasing the levels of spine involved in fixation. In its simplest form it applies to fixation one level above and one level below the fractured vertebra. It has proven effective with good clinical, functional and radiological results in well selected cases. However not insignificant rates of sagittal collapse and recurrence of kyphosis with or without clinical implications have also been reported. Most of the failures were attributed to lack of anterior column integrity and relatively inferior robustness of earlier posterior short segment constructs. With better understanding of fracture biomechanics, better implant designs and evolution of strategies to increase the biomechanical strengths of posterior constructs, the rates of kyphosis recurrence and implant failure have been significantly reduced. Although there is lack of robust evidence to guide a surgeon to the best approach for a particular fracture, adhering to basic biomechanical principals increases the efficacy and reliability of short segment fixation. This narrative review highlights the status of short segment fixation in dorsolumbar spine injuries with emphasis on patient selection and strategies to increase effectiveness and reduce failures of short segment fixation.
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Weng F, Wang J, Yang L, Zeng J, Chu Y, Tian Z. Application value of expansive pedicle screw in the lumbar short-segment fixation and fusion for osteoporosis patients. Exp Ther Med 2018; 16:665-670. [PMID: 30112031 PMCID: PMC6090430 DOI: 10.3892/etm.2018.6248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/22/2018] [Indexed: 12/25/2022] Open
Abstract
Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.
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Affiliation(s)
- Fengbiao Weng
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Jiazi Wang
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Liwen Yang
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Jincai Zeng
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Yawei Chu
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Zhigang Tian
- Department of Orthopaedics, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
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Che W, Chen Q, Ma YQ, Jiang YQ, Yuan W, Zhou XG, Li XL, Dong J. Single-Level Rigid Fixation Combined with Coflex: A Biomechanical Study. Med Sci Monit 2016; 22:1022-7. [PMID: 27021044 PMCID: PMC4815995 DOI: 10.12659/msm.896706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this biomechanical in vitro study was to compare the kinematics and intradiscal pressure achieved with 2 methods: L4-L5 pedicle screw-rod fixation (PSRF) with an upper L3-L4 Coflex device and L4-L5 PSRF alone. The results were used to characterize the biomechanics of the topping-off operation with a Coflex device for the lumbar motion segment adjacent to single-level rigid fixation. MATERIAL/METHODS Six human cadaveric spine specimens were biomechanically tested in vitro (6 males, 0 females). The 3-dimensional specimen motion in response to applied loads during flexibility tests was determined. Loads were applied along anatomic axes to induce flexion-extension, lateral bending, and axial rotation. All specimens were first studied with intact lumbar motion segments, then with L4-L5 PSRF alone, and finally with L4-L5 PSRF with an upper L3-L4 Coflex device. A non-paired comparison of the 3 configurations under 3 different conditions was made. RESULTS PSRF, with or without a Coflex device, significantly increased the range of motion (ROM) in the upper adjacent motion segments in all directions of loading. The intradiscal pressure (IDP) changed slightly. A correlation analysis showed that the ROM and IDP are significantly positively correlated. The application of the upper motion segment of the Coflex device provided greater stability in all directions of motion than did PSRF alone, particularly for extension (p<0.05), while use of a Coflex device did not significantly decrease the IDP compared with PSRF alone (p>0.05). CONCLUSIONS These results suggest that L4-L5 PSRF with an L3-L4 Coflex device is more stable than L4-L5 PSRF alone. PSRF with an upper Coflex device is a promising alternative to PSRF alone. Based on these biomechanical tests, it might be considered a protective method to prevent adjacent segment degeneration (ASD), although some limitations with this in vitro study must be addressed in the future.
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Affiliation(s)
- Wu Che
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Yi-Qun Ma
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Yun-Qi Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Wei Yuan
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (mainland)
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