Biomechanical considerations of the posterior surgical approach to the lumbar spine

Haupt, Samuel; Cornaz, Frédéric; Falkowski, Anna L.; Widmer, Jonas; Farshad, Mazda

doi:10.1016/j.spinee.2022.08.006

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…This was attributed to the following reasons: (1) The bone cement used in this study was polymethyl methacrylate, which is soluble in organic solvents such as ethanol, and formaldehyde, which was utilized to x cadaveric specimens, is the same organic solvent as ethanol [20]. (2) The low temperature in the bone marrow cavity of the cadaveric specimen in this study also had an impact on the hardening of the bone cement. Therefore, such aspects should be considered in future studies of this nature.…”

Section: Discussionmentioning

confidence: 99%

“…* Email: 728887618@qq.com. and thus, restoring the normal anatomical sequence of the lumbosacral spine and re-establishing its stability are essential components of the surgical technique used in lumbar surgery [2].…”

Section: Introductionmentioning

confidence: 99%

“…The lumbosacral segment is the foundation of the entire spinal biomechanics, 1 Department of spine surgery, Loudi Hospital, Hengyang Medical School, University of South China Loudi ,China,Hunan, China. 2 College of Computer Science and Technology,Huazhong University of Science and Technology,Wuhan City ,Hubei Province ,China. 3 Department of spine surgery, Loudi central Hospital,Loudi city, Hunan Province,China .…”

Section: Introductionmentioning

confidence: 99%

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Maximum extraction force of a cement-reinforced transsacral-2-sacral-wing screw

Tong

CHEN

Chen

et al. 2023

Preprint

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Purpose To measure the maximum extraction force of cement-reinforced transsacral-2-sacral-wing screw fixation and to investigate the effectiveness of this internal fixation method.Methods Five adult cadaver specimens fixed with formaldehyde solution and moistened, as well as six fresh frozen cadavers, were utilized for this study. Three types of sacral screws were randomly placed on both sides of the same cadaveric specimen, including: (1) trans-sacral 2 sacral wing cement-reinforced screws (group S2); (2) S1-pedicle screws (group S1); and (3) sacral 2 sacroiliac screws (group S2AI). The immediate maximum extraction force values of the sacral screws in the three groups were recorded by applying axial extraction force to the screws. Statistical analysis was performed using ANOVA in SPSS 19.0, and statistical significance was set at P < 0.05. These findings provide insights into the biomechanical properties of sacral screws and could have implications for clinical applications.Results The maximum axial extraction force of the screws in group S2 was (521.80 ± 98.98) N; in group S1 was (843.16 ± 107.64) N; and in group S2AI was (536.04 ± 145.78) N. The results revealed that the maximum axial extraction force in group S1 was significantly stronger than that in groups S2 and S2AI (P < 0.001). In contrast, the maximum axial extraction force in groups S2 and S2AI was not significantly different (P > 0.05). Furthermore, in formaldehyde-fixed specimens, the maximum axial extraction force was significantly stronger in the S1 group than in the S2 and S2AI groups (P < 0.001), and in the S2 group than in the S2AI group (P < 0.05). Similar results were obtained in freshly frozen cadaveric specimens, where the maximum axial extraction force in group S1 was significantly stronger than that in groups S2 and S2AI (P < 0.001), and there was no significant difference between groups S2 and S2AI (P > 0.05).Conclusion In formaldehyde-fixed cadaveric specimens, the maximum axial extraction force of cement-reinforced transsacral-2-sacral-wing screw fixation was lower than that of S1-pedicle screw fixation, but higher than that of sacral 2 sacroiliac screw fixation. However, in freshly frozen cadaveric specimens, the difference in maximum extraction force between the S2 and S2AI groups was not statistically significant. Biomechanical experiments demonstrated that cement-reinforced transsacral-2-sacral-wing screws exhibit a significant effect on anti-pullout force performance, and may offer strong distal fixation. These screws may be an alternative to provide an effective force for spinal pelvic fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maximum extraction force of a cement-reinforced transsacral-2-sacral-wing screw

Tong

CHEN

Chen

et al. 2023

Preprint

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“…[ 1 , 2 , 8 , 10 ] Second, the paraspinal muscles, fascia, and supraspinal ligament should be closed in two or even three separate layers using interrupted-X stitches 0 or 1-0 Vicryl sutures. [ 3 , 4 , 12 , 14 ] Alternatively, one could choose to use, stronger, and longer-lasting PDS Polydioxanone sutures (PDS II:) absorbable suture maintain; 25% of tensile strength at 42 days; resorbs 130–180 days). [ 7 ] Third, closure of subcutaneous tissues should employ inverted Vicryl 2-0 in two planes for tissues >25 mm in depth.…”

Section: Discussionmentioning

confidence: 99%

Variability in wound closure technique in midline posterior lumbar fusion surgery. International survey and standardized closure technique proposal

Aguilar

Sida

Betancourt

et al. 2022

Surgical Neurology International

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Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery – 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a “consensus technique.” Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.

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