Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy

Barbera, Luigi La; Brayda-Bruno, Marco; Liebsch, Christian; Villa, Tomaso; Luca, Andrea De; Galbusera, Fabio; Wilke, Hans–Joachim

doi:10.1007/s00586-018-5623-z

Cited by 49 publications

(47 citation statements)

References 35 publications

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“…A limitation of the present work is the sample size: five specimens have a limited statistical power. It worth noticing that the results here reported are in agreement with the kinematics data reported for a larger specimens' cohort [44]. As this study is extremely demanding in terms of costs, testing and strain analysis, it was not possible to extend to a larger sample.…”

Section: Clockwise Vs Counterclockwise Axial Torsionsupporting

confidence: 86%

The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis

et al. 2020

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Section: Clockwise Vs Counterclockwise Axial Torsionsupporting

confidence: 86%

The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis

et al. 2020

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“…PSO procedure is often accompanied by a high risk of rod breakage and pseudarthrosis at the osteotomy level due to the extensive resection through posterior, middle and anterior bony and ligamentous structures, featuring unique biomechanical challenges [2][3][4][5][6][7][8][9] . Previous biomechanical studies demonstrated improved primary stability and reduced instrumentation loads using multi-rod constructs and additional interbody spacers [11][12][13][14][15][16][17][18][19] . However, they focused on the load supported by the posterior instrumentation in relation to rod breakage, neglecting the load supported by the anterior column, which is fundamental to promote fusion across the osteotomy early after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…During the flexibility tests, the primary rods at PSO level were posteriorly instrumented with rectangular strain gauge (SGs) rosettes (KFG-2-120-D17-11L1M2S; Kyowa Electronic Instruments Co. Ltd, Tokyo, Japan) on the most posterior part of the rods 11,12,35,36 . Compensation of thermal effects was achieved connecting each SG to a dummy compensator in a half-bridge configuration to a MX840B (HBM, Darmstadt, Germany) amplifier.…”

Section: Strain Gauge Analysis On Primary Rodsmentioning

confidence: 99%

Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy

Barbera

Wilke

Ruspi

et al. 2021

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Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion–extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature.

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“…This could be a starting point for other studies in which the behavior of other ligaments could be investigated under different loading conditions or after surgical interventions on the spine [36].…”

Section: Discussionmentioning

confidence: 99%

Digital Image Correlation (DIC) Assessment of the Non-Linear Response of the Anterior Longitudinal Ligament of the Spine during Flexion and Extension

et al. 2020

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While the non-linear behavior of spine segments has been extensively investigated in the past, the behavior of the Anterior Longitudinal Ligament (ALL) and its contribution during flexion and extension has never been studied considering the spine as a whole. The aims of the present study were to exploit Digital Image Correlation (DIC) to: (I) characterize the strain distribution on the ALL during flexion-extension, (II) compare the strain on specific regions of interest (ROI) of the ALL in front of the vertebra and of the intervertebral disc, (III) analyze the non-linear relationship between the surface strain and the imposed rotation and the resultant moment. Three specimens consisting of 6 functional spinal units (FSUs) were tested in flexion-extension. The full-field strain maps were measured on the surface of the ALL, and the most strained areas were investigated in detail. The DIC-measured strains showed different values of peak strain in correspondence with the vertebra and the disc but the average over the ROIs was of the same order of magnitude. The strain-moment curves showed a non-linear response like the moment-angle curves: in flexion the slope of the strain-moment curve was greater than in extension and with a more abrupt change of slope. To the authors’ knowledge, this is the first study addressing, by means of a full-field strain measurement, the non-linear contribution of the ALL to spine biomechanics. This study was limited to only three specimens; hence the results must be taken with caution. This information could be used in the future to build more realistic numerical models of the spine.

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Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy

Cited by 49 publications

References 35 publications

The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis

The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis

Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy

Digital Image Correlation (DIC) Assessment of the Non-Linear Response of the Anterior Longitudinal Ligament of the Spine during Flexion and Extension

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