Biomechanical comparison of semirigid junctional fixation techniques to prevent proximal junctional failure after thoracolumbar adult spinal deformity correction

Doodkorte, Remco J.P.; Roth, Alex K.; Arts, Jacobus J.; Lataster, L. M. A.; Rhijn, Lodewijk W. van; Willems, Paul

doi:10.1016/j.spinee.2021.01.017

Cited by 13 publications

(28 citation statements)

References 35 publications

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“…When comparing the current study to relevant literature, the findings are in agreement with other biomechanical studies. In a previous study using human spine segments, TPH and Tape2 achieved the most gradual transition in ROM for 1- and 2-level junctional fixation, respectively 15 . Despite the anatomical differences between human and porcine spines, both techniques performed in accordance with those previous results in the current study using porcine spine segments.…”

Section: Discussionsupporting

confidence: 88%

“…These techniques aim to reduce the stresses on the junctional vertebrae and ligaments by providing a more gradual transition in range of motion (ROM) at the proximal end of a PSF construct. In a previous biomechanical study in human cadaveric spine segments, several of these techniques were compared 15 . This study confirmed the potential of transverse process hooks (TPH) as a 1-level semi-rigid junctional fixation technique and demonstrated that the use of a knotted sublaminar tape at 2 consecutive levels could extend this transition zone over 2 motion segments.…”

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confidence: 57%

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Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery

Doodkorte

Roth

Jacobs

et al. 2021

Spine

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A porcine cadaveric biomechanical study. Objective. To biomechanically evaluate a novel Cable Anchor System as semi-rigid junctional fixation technique for the prevention of proximal junctional failure after adult spinal deformity surgery and to make a comparison to alternative promising prophylactic techniques. Summary of Background Data. The abrupt change of stiffness at the proximal end of a pedicle screw construct is a major risk factor for the development of proximal junctional failure after adult spinal deformity surgery. A number of techniques that aim to provide a gradual transition zone in range of motion (ROM) at the proximal junction have previously been studied. In this study, the design of a novel Cable Anchor System, which comprises a polyethylene cable for rod fixation, is assessed. Methods. Ten T6-T13 porcine spine segments were subjected to cyclic 4 Nm pure-moment loading. The following conditions were tested: uninstrumented, 3 level pedicle screw fixation (PSF), and PSF with supplementary Cable Anchors applied proximally at 1-level (Anchor1) or 2-levels (Anchor2), transverse process hooks (TPH), and 2-level sublaminar tapes (Tape2). The normalized segmental range of motion in the junctional zone was compared using one-way analysis of variance and linear regression.Results. Statistical comparison at the level proximal to PSF showed significantly lower ROMs for all techniques compared to PSF fixation alone in all movement directions. Linear regression demonstrated a higher linearity for Anchor1 (0.820) and Anchor2 (0.923) in the junctional zone in comparison to PSF (1-level: 0.529 and 2-level: 0.421). This linearity was similar to the compared techniques (TPH and Tape2). Conclusion. The Cable Anchor System presented in this study demonstrated a gradual ROM transition zone at the proximal end of a rigid pedicle screw construct similar to TPH and 2-level sublaminar tape semi-rigid junctional fixation constructs, while providing the benefit of preserving the posterior ligament complex.

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Section: Discussionsupporting

confidence: 88%

supporting

confidence: 57%

Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery

Doodkorte

Roth

Jacobs

et al. 2021

Spine

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“…Motions of the individual vertebrae were obtained with triplet LED‐markers rigidly fixed to each vertebra with custom‐made pins and tracked using an optical registration system (Optotrak Certus, Northern Digital, Waterloo, Ontario, Canada). The data were automatically gathered by the spine tester software (FS21; Applied Test Systems, Buttler, PA, USA) and segmental rotations were calculated using a custom‐written algorithm based on Tait‐Bryan angle sequence (MATLAB R2018b, MathWorks, Natick, MA, USA) 29 . Based on these calculations, data of the fourth cycle was used to determine the segmental ROM in all three degrees of freedom, defined as the difference in rotation at maximum and minimum load.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of a novel biomimetic artificial intervertebral disc in canine cervical cadaveric spines

et al. 2023

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Background Context Cervical disc replacement (CDR) aims to restore motion of the treated level to reduce the risk of adjacent segment disease (ASD) compared with spinal fusion. However, first‐generation articulating devices are unable to mimic the complex deformation kinematics of a natural disc. Thus, a biomimetic artificial intervertebral CDR (bioAID), containing a hydroxyethylmethacrylate (HEMA)—sodium methacrylate (NaMA) hydrogel core representing the nucleus pulposus, an ultra‐high‐molecular‐weight‐polyethylene fiber jacket as annulus fibrosus, and titanium endplates with pins for primary mechanical fixation, was developed. Purpose To assess the initial biomechanical effect of the bioAID on the kinematic behavior of the canine spine, an ex vivo biomechanical study in 6‐degrees‐of‐freedom was performed. Study Design A canine cadaveric biomechanical study. Methods Six cadaveric canine specimens (C3‐C6) were tested in flexion‐extension (FE), lateral bending (LB) axial rotation (AR) using a spine tester in three conditions: intact, after C4‐C5 disc replacement with bioAID, and after C4‐C5 interbody fusion. A hybrid protocol was used where first the intact spines were subjected to a pure moment of ±1 Nm, whereafter the treated spines were subjected to the full range of motion (ROM) of the intact condition. 3D segmental motions at all levels were measured while recording the reaction torsion. Biomechanical parameters studied included ROM, neutral zone (NZ), and intradiscal pressure (IDP) at the adjacent cranial level (C3‐C4). Results The bioAID retained the sigmoid shape of the moment‐rotation curves with a NZ similar to the intact condition in LB and FE. Additionally, the normalized ROMs at the bioAID‐treated level were statistically equivalent to intact during FE and AR while slightly decreased in LB. At the two adjacent levels, ROMs showed similar values for the intact compared to the bioAID for FE and AR and an increase in LB. In contrast, levels adjacent to the fused segment showed an increased motion in FE and LB as compensation for the loss of motion at the treated level. The IDP at the adjacent C3‐C4 level after implantation of bioAID was close to intact values. After fusion, increased IDP was found compared with intact but did not reach statistical significance. Conclusion This study indicates that the bioAID can mimic the kinematic behavior of the replaced intervertebral disc and preserves that for the adjacent levels better than fusion. As a result, CDR using the novel bioAID is a promising alternative treatment for replacing severely degenerated intervertebral discs.

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“…Second, various instrumentation techniques have been developed to prevent PJK. In general, these techniques attempt to create a “soft landing,” which refers to distributing the force of the construct across multiple levels along the UIV 130. Most notably, in the upper thoracic spine, the substitution of the UIV pedicle screw with a transverse process hook has been suggested as a strategy to prevent PJK 129.…”

Section: Radiographic Failurementioning

confidence: 99%

“…In general, these techniques attempt to create a "soft landing," which refers to distributing the force of the construct across multiple levels along the UIV. 130 Most notably, in the upper thoracic spine, the substitution of the UIV pedicle screw with a transverse process hook has been suggested as a strategy to prevent PJK. 129 Hooks have been shown to provide a more gradual transition of motion at the UIV, creating the desired "soft landing" for the instrumentation.…”

Section: Literature Reviewmentioning

confidence: 99%

Failure in Adult Spinal Deformity Surgery

Burke

Lau

Safaee

et al. 2022

Spine

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Study Design. Literature review.Objective. The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes. Summary of Background Data. There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure. Methods. A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed.Results. Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes. . clinical failure, radiographic failure, the need for reoperation, and lack of costeffectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures. Conclusion. By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.

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Biomechanical comparison of semirigid junctional fixation techniques to prevent proximal junctional failure after thoracolumbar adult spinal deformity correction

Cited by 13 publications

References 35 publications

Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery

Biomechanical Evaluation of Semi-rigid Junctional Fixation Using a Novel Cable Anchor System to Prevent Proximal Junctional Failure in Adult Spinal Deformity Surgery

Biomechanical evaluation of a novel biomimetic artificial intervertebral disc in canine cervical cadaveric spines

Failure in Adult Spinal Deformity Surgery

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