A Comparison of Single-Level Fusions With and Without Hardware

Lorenz, Mark; Zindrick, Michael R.; Schwaegler, Paul; Vrbos, Lori; Collatz, Mary Ann; Behal, Raj; Cram, Richard

doi:10.1097/00007632-199108001-00029

Cited by 121 publications

(34 citation statements)

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“…Although a solid arthrodesis is not always synonymous with a good clinical outcome, the incidence of fusion remains the most important criterion for evaluation of the effectiveness of a given arthrodesis technique. With a 6.5% nonunion rate, our data further strengthen the positive results reported in the literature regarding the high rate of fusion achieved with pedicle instrumentation [4,5,11,13,15,16,21,24,25]. The biomechanical advantages of pedicle screw instrumentation are stability and rigid fixation.…”

Section: Discussionsupporting

confidence: 86%

“…Lumbosacral arthrodesis has undergone a fast evolution characterized by controversial results [4,5,11,13,15,16,21,24,25] as witnessed by various and complex problems not yet classified. Arthrodesis without instrumentation [19,23,27], Harrington rods [9] and Luque segmental wire fixation [14] represented different solutions to the same problem: chronic lumbar pain and instability.…”

Section: Discussionmentioning

confidence: 99%

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Lumbosacral arthrodesis using pedicular screws and ringed rods

et al. 1997

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Sixty-one patients who had lumbar instability and chronic low back pain or deformity from nontraumatic lumbar pathologies were studied. In all of them a posterior lumbosacral fusion with CUN (Clinic of the University of Navarre) pedicle rod fixation was used. The mean follow-up period was 36 months (range 26--46 months). The consolidation rate was evaluated according to plain and functional radiographs, and a clinical evaluation was made using an analogue pain scale. The rate of fusion was 93.5%. Neurological complications occurred in 3.3%. The incidence of screw failure was 2.3% of all the screws. No other implant failure occurred. The patients rated their clinical results as 'excellent' in 33.8% of the cases, 'good' in 42.2%, 'fair' in 16.9% and 'poor' in 6.7%. CUN instrumentation is a versatile internal fixation system that has been shown to provide satisfactory stability. Furthermore, the clinical results are comparable to those reported in studies in which the most common hardwares were used.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Lumbosacral arthrodesis using pedicular screws and ringed rods

et al. 1997

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“…Whether transpedicular screw fixation in lumbar spine fusions increases the healing speed, rate and outcome is a matter of debate: positive [13,20] as well as negative [5,14,18] reports exist in the literature. An increased complication rate and increased operating costs are, however, well known and may call into question their routine use [19,21].…”

Section: Discussionmentioning

confidence: 99%

A method to evaluate the in vivo behaviour of lumbar spine implants

Gunnarsson

Axelsson

Johnsson

et al. 2000

European Spine Journal

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IntroductionThere are many ways to fuse the lumbar spine, and indications vary, especially concerning degenerative disorders. The fact that indications vary and often have not been sufficiently validated must, however, not draw our interest from the technical aspects of the procedure, which ideally involves minimal trauma, has few complications and yields a high fusion rate.The abundance of implants on the market and techniques used today further emphasize a need to evaluate Abstract The aim of the study was to design a method for evaluating the stabilizing effect of different lumbar spine implants in vivo, and to apply this method to a comparison of plates versus rods in lumbar spine posterolateral fusion using transpedicular screw fixation. Fourteen patients, seven operated on with transpedicular plates and screws (VSP), and seven operated on with rods and screws (Diapason), matched according to number of levels fused, had tantalum markers inserted in the vertebrae at surgery, enabling roentgen stereophotogrammetric analysis (RSA). Mean patient age was 45 (range 33-56) years. In each group, two patients underwent fusion between L4 and L5, three between L5 and S1, and two from L4 to S1. In three patients, concomitant nerve root decompression was performed using a facet joint preserving technique. RSA was performed 4 weeks after surgery. This interval was chosen to allow enough time for soft tissue healing, but not fusion healing, to occur. RSA was performed in supine and standing position without any mobility provocation, in line

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“…Pain relief and rates of return to work were also drastically improved by the addition of instrumentation [19].…”

Section: Introductionmentioning

confidence: 99%

In vitro testing of a new transpedicular stabilization technique

et al. 1997

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The rigidity of a pedicle screw implant is a critical biomechanical variable in lumbar spinal fusions. Sufficient rigidity is required for integration of bone grafts and to promote healing. Osteopenia, stress shielding, and compensatory hypermobility have been described as consequences of excessive rigidity. Little is known about the biomechanical characteristics of "semirigid" compared to "rigid" implants. A new implant, whose rigidity can be varied by selection of different implant components, was tested in vitro under well-defined loading conditions. The three-dimensional load-displacement behavior of all lumbar vertebrae involved in or adjacent to the two-level fusion was evaluated for two fusion modifications: bilateral rigid and bilateral semirigid. Cyclic fatigue loading was subsequently carried out under realistic conditions and motion testing repeated. The rigid device reduced the motion of the L3-4 transfixed segment in the primary movement planes by 87.3% with respect to the intact spine value in flexion/extension (FE), 86.3% in lateral bending (LB), and 76.8% in axial rotation (AR). The semirigid device achieved a reduction in motion of 79.6% (FE), 82.7% (LB), and 51.7% (AR). The semirigid implant was particularly easy to insert, because no bending of rods or plates was necessary. The implants showed no loosening or breakage after the fatigue testing. The results are compared to other available systems and the underlying biomechanics discussed.

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A Comparison of Single-Level Fusions With and Without Hardware

Cited by 121 publications

References 0 publications

Lumbosacral arthrodesis using pedicular screws and ringed rods

Lumbosacral arthrodesis using pedicular screws and ringed rods

A method to evaluate the in vivo behaviour of lumbar spine implants

In vitro testing of a new transpedicular stabilization technique

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