Contribution of Round vs. Rectangular Expandable Cage Endcaps to Spinal Stability in a Cadaveric Corpectomy Model

Eastlack, Robert K.; Moazzaz, Payam; Turner, Alexander W.; Cornwall, G. Bryan

doi:10.14444/2053

Cited by 22 publications

(12 citation statements)

References 42 publications

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“…During the testing the stiffness for both lateral bending and torsion decreased significantly in most of the specimens compared with the intact state (phase I). These findings correspond both to those of Wong et al, 32 who found kyphoplasty as a stand-alone treatment was unable to restore the stiffness of an intact specimen in vertebral burst fractures and to those of Mundis et al, 33 who described an increased motion in lateral bending for expandable cages . Furthermore, the approach in this study appears to show similar results compared to a cement augmentation, which did also not show an improvement in torsional stiffness ( P = .72).…”

Section: Discussionsupporting

confidence: 89%

“…However, lag-screws as a stand-alone solution do not seem to improve the specimen’s stiffness significantly. This corresponds to other studies that have dealt with lag-screws, 37 as well as studies dealing with kyphoplasty 32 or cages 33 as stand-alone treatments in vertebral fractures. Furthermore, a decreasing IVS appeared during the testing, which correlates to a progressive collapse of the IVD into the vertebral body and might be the reason for repeatedly reported vertebral nonunion.…”

Section: Discussionsupporting

confidence: 78%

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Lag-Screw Osteosynthesis in Thoracolumbar Pincer Fractures

Auerswald

Messer-Hannemann

Sellenschloh

et al. 2020

Global Spine Journal

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Study Design: Biomechanical. Objective: This study evaluates the biomechanical properties of lag-screws used in vertebral pincer fractures at the thoracolumbar junction. Methods: Pincer fractures were created in 18 bisegmental human specimens. The specimens were assigned to three groups depending on their treatment perspective, either bolted, with the thread positioned in the cortical or cancellous bone, or control. The specimens were mounted in a servo-hydraulic testing machine and loaded with a 500 N follower load. They were consecutively tested in 3 different conditions: intact, fractured, and bolted/control. For each condition 10 cycles in extension/flexion, torsion, and lateral bending were applied. After each tested condition, a computed tomography (CT) scan was performed. Finally, an extension/flexion fatigue loading was applied to all specimens. Results: Biomechanical results revealed a nonsignificant increase in stiffness in extension/flexion of the fractured specimens compared with the intact ones. For lateral bending and torsion, the stiffness was significantly lower. Compared with the fractured specimens, no changes in stiffness due to bolting were discovered. CT scans showed an increasing fracture gap during axial loading both in extension/flexion, torsion, and lateral bending in the control specimens. In bolted specimens, the anterior fragment was approximated, and the fracture gap nullified. This refers to both the cortical and the cancellous thread positions. Conclusion: The results of this study concerning the effect of lag-screws on pincer fractures appear promising. Though there was little effect on stiffness, CT scans reveal a bony contact in the bolted specimens, which is a requirement for bony healing.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 78%

Lag-Screw Osteosynthesis in Thoracolumbar Pincer Fractures

Auerswald

Messer-Hannemann

Sellenschloh

et al. 2020

Global Spine Journal

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“…However, the stability of conventional pedicle screw fixation for patients with osteoporosis is significantly reduced due to lumbar osteoporosis, and it is difficult to achieve a solid internal fixation effect ( 8 ). Expansive pedicle screw can fix the vertical axial section through the front expansive effect ( 9 ), thus forming the triangular support ( 10 ), and significantly increasing the screw bonding ( 11 ); at the same time, the surrounding bone trabecula is appropriately compressed, thereby further improving the bone density and the stability of internal fixation ( 12 ). In addition, the front end of internal fixation screw after expansion can expand to both sides, thus effectively embedding into the bone and better improving the anti-rotation capacity of the screw ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

et al. 2018

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Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.

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“…We prefer to use a wide-footprint cage packed with locally collected morselized autograft and the surgeon's choice of allograft. Wide footprint rectangular cages (such as X-CORE ® , NuVasive, Inc.) span the hard cortical bone edges of the adjacent vertebral bodies and may help to decrease subsidence (41)(42)(43). This presents as one of the greatest advantages of the lateral approach compared to a posterolateral approach, where only a circular footplate cage can be placed.…”

Section: Surgical Approach and Considerationsmentioning

confidence: 99%

Minimally invasive surgery for thoracolumbar spinal trauma

Walker¹,

Xu²,

Godzik³

et al. 2018

Ann. Transl. Med.

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The indications for operative intervention after thoracolumbar spine trauma have been well described. Advances in minimally invasive techniques, including percutaneous pedicle screw fixation and mini-open anterolateral retractor-based approaches can improve surgical outcomes when appropriately applied by reducing blood loss, operative duration and post-operative pain. Moreover, they allow for theoretical advantages by preservation of muscular and skeletal blood supply and innervation that is typically lost during the muscular dissection of open approaches. For thoracolumbar spine fractures, percutaneous fixation allows for internal bracing of unstable fractures during healing while maintaining sagittal alignment. In instances of neurological compromise from fracture retropulsion, corpectomies may be required, and mini-open lateral approaches adopted from degenerative disease applications allow for a minimally invasive manner to treat the defect. These further allow for placement of wide rectangular-footprint expandable vertebral body replacement devices to provide anterior column support. We believe this allows for lower rates of subsidence and helps to maintain the biomechanical integrity necessary to prevent post-traumatic malalignment and kyphosis. Together, these minimally invasive techniques combined supply the spine surgeon with a minimally invasive armamentarium to treat nearly all thoracolumbar spine trauma. Surgeons should be comfortable with the strengths and shortcomings of these approaches in order to successfully apply them for this pathology.

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Contribution of Round vs. Rectangular Expandable Cage Endcaps to Spinal Stability in a Cadaveric Corpectomy Model

Cited by 22 publications

References 42 publications

Lag-Screw Osteosynthesis in Thoracolumbar Pincer Fractures

Lag-Screw Osteosynthesis in Thoracolumbar Pincer Fractures

Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

Minimally invasive surgery for thoracolumbar spinal trauma

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