Attenuation of Proximal Junctional Kyphosis Using Sublaminar Polyester Tension Bands: A Biomechanical Study

Cho, Samuel K.; Caridi, John M.; Kim, Jun; Cheung, Zoe B.; Gandhi, Anup; Inzana, Jason A.

doi:10.1016/j.wneu.2018.08.244

Cited by 16 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, a reduced IDP in flexion (p=.01) and in axial rotation (p=.03) was found. In turn, these results are similar to the findings of Cho et al who measured a reduction in flexion (p<.05) and extension ROM (p<.0001) in a pretension dependent manner [27]. Notably, in this study the tethers were pretensioned to 250N and 350N, which resulted in an altered sagittal alignment towards extension at the index level of 0.7 §0.6˚and 1.0 § 0.8˚, respectively.…”

Section: Suture Loops and Tetherssupporting

confidence: 90%

“…1, B). Alternatively, three studies investigated the use of tethers in human cadaveric pure bending tests [27,29,32]. Tethers were connected from either the spinous process or from the lamina at the UIV+1 (and/or UIV+2) to a crosslink at UIV-1, usually pretensioned by caudal displacement of the crosslink (Fig.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…1, C). This was achieved using Mersilene tape [29,32] or commercially available sublaminar wires [27].…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…Two studies investigating hand tied (non-tensioned) suture loops, did not find any significant effect of suture loops on the ROM at index level [27,28]. Mar et al (2019a) investigated the effect of different pretension levels (0, 22, 44, 66, 88N) of suture loops on single human functional spinal units (T11−T12) and measured a reduced flexion ROM as well as decreased IDPs with increasing suture loop pretension [30].…”

Section: Suture Loops and Tethersmentioning

confidence: 99%

See 3 more Smart Citations

Instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction—a systematic review of biomechanical studies

et al. 2021

View full text Add to dashboard Cite

Section: Suture Loops and Tetherssupporting

confidence: 90%

Section: Description Of Included Studiesmentioning

confidence: 99%

“…1, C). This was achieved using Mersilene tape [29,32] or commercially available sublaminar wires [27].…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Section: Suture Loops and Tethersmentioning

confidence: 99%

See 2 more Smart Citations

Instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction—a systematic review of biomechanical studies

et al. 2021

View full text Add to dashboard Cite

“…22 Recently, a number of studies have analyzed these possibilities both biomechanically and clinically for clamp-based sublaminar systems. [23][24][25] The low fatigue strength of metal cables does not allow for stand-alone fixation at construct ends, and thus the use of UHMWPE tape may offer great benefit. Therefore, thorough biomechanical comparisons in human cadaver thoracolumbar spine segments should be performed to elucidate this additional potential benefit.…”

Section: Discussionmentioning

confidence: 99%

Ultra–high-molecular-weight polyethylene sublaminar tape as semirigid fixation or pedicle screw augmentation to prevent failure in long-segment spine surgery: an ex vivo biomechanical study

Doodkorte

Belda

Roth

et al. 2021

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEComplications after adult spinal deformity surgery are common, with implant-related complications occurring in up to 27.8% of cases. Sublaminar wire fixation strength is less affected by decreasing trabecular bone density in comparison to pedicle screw (PS) fixation due to the predominant cortical bone composition of the lamina. Sublaminar fixation may thus aid in decreasing implant-related complications. The goal of this study was to compare fixation characteristics of titanium sublaminar cables (SCs), ultra–high-molecular-weight polyethylene (UHMWPE) tape, PSs, and PSs augmented with UHMWPE tape in an ex vivo flexion–bending setup.METHODSThirty-six human cadaver vertebrae were stratified into 4 different fixation groups: UHMWPE sublaminar tape (ST), PS, metal SC, and PS augmented with ST (PS + ST). Individual vertebrae were embedded in resin, and a flexion–bending moment was applied that closely resembles the in vivo loading pattern at transitional levels of spinal instrumentation.RESULTSThe failure strength of PS + ST (4522 ± 2314 N) was significantly higher compared to the SC (2931 ± 751 N) and PS (2678 ± 827 N) groups, which had p values of 0.028 and 0.015, respectively (all values expressed as the mean ± SD). Construct stiffness was significantly higher for the PS groups compared to the stand-alone sublaminar wiring groups (p = 0.020). In contrast to SC, ST did not show any case of cortical breach.CONCLUSIONSThe higher failure strength of PS + ST compared to PS indicates that PS augmentation with ST may be an effective measure to reduce the incidence of screw pullout, even in osteoporotic vertebrae. Moreover, the lower stiffness of sublaminar fixation techniques and the absence of damage to the cortices in the ST group suggest that ST as a stand-alone fixation technique in adult spinal deformity surgery may also be clinically feasible and offer clinical benefits.

show abstract

The influence of ligament biomechanics on proximal junctional kyphosis and failure in patients with adult spinal deformity

Blais,

Shahidi,

Anderson

et al. 2023

JOR Spine

View full text Add to dashboard Cite

PurposeIt is unknown whether the biomechanics of the posterior ligamentous complex (PLC) are impaired in individuals undergoing surgery for adult spinal deformity (ASD). Characterizing these properties may improve our understanding of proximal junctional kyphosis (PJK; defined as proximal junctional angle [PJA] of >10 deg from UIV‐1 to UIV + 2), as well as proximal junctional failure (PJF; symptomatic PJK requiring revision). The purpose of this prospective observational study is to compare biomechanical properties of the PLC in individuals with ASD who do, and do not develop PJK or PJF within 1 year of spinal fusion surgery.MethodsIntraoperative biopsies of PLC were obtained from 32 consecutive patients undergoing spinal fusions for ASD (>4 levels). Ligament peak force, tensile stress, tensile strain, and elastic modulus (EM) were measured with a materials testing system. Biomechanical properties and tissue dimensions were correlated with age, gender, BMI, vitamin D level, osteoporosis, sagittal alignment, PJA and change in PJA preoperatively, within 3 months, and at 1 year postoperatively.ResultsLonger ligaments were associated with greater PJA change at 3 months (p = 0.04), and thinner ligaments were associated with greater PJA change at 1 year (r = 0.57, p = 0.01). Greater EM was associated with greater PJA at both 3 months and 1 year (p = 0.03). Five participants had a change in PJA of >10 1 year postoperatively, and three participants demonstrated PJF. EM was significantly higher in individuals who required revision surgery (p = 0.003), and ligament length was greater (p = 0.03). Preoperative sagittal alignment was not related to incidence of revision surgery (p > 0.10).ConclusionsThe biomechanical properties of the PLC may be associated with higher risk for proximal failure. Ligaments that are longer, thinner, and less elastic are associated with higher postoperative PJA. Furthermore stiffer EM of the ligament is associated with the need for revision surgery.

show abstract

Attenuation of Proximal Junctional Kyphosis Using Sublaminar Polyester Tension Bands: A Biomechanical Study

Cited by 16 publications

References 30 publications

Instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction—a systematic review of biomechanical studies

Instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction—a systematic review of biomechanical studies

Ultra–high-molecular-weight polyethylene sublaminar tape as semirigid fixation or pedicle screw augmentation to prevent failure in long-segment spine surgery: an ex vivo biomechanical study

The influence of ligament biomechanics on proximal junctional kyphosis and failure in patients with adult spinal deformity

Contact Info

Product

Resources

About