Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? An in vitro biomechanical study

Duff, John Michael; Hussain, Mir; Klocke, Noelle; Harris, Jonathan; Yandamuri, Soumya S; Bobinski, Lukas; Daniel, Roy Thomas; Bucklen, Brandon

doi:10.1016/j.clinbiomech.2018.02.009

Cited by 18 publications

(13 citation statements)

References 48 publications

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“…Cyclic loading protocols are designed to simulate the stresses placed upon a construct before bony fusion. If fusion does not occur in 6–8 weeks, constructs are at increased risk for failure 33,34. Prior literature suggests that 18,000 cycles are needed to simulate the time required for fusion to occur 33–35.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Murphy¹,

Colantonio²,

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective: To compare multilevel posterior cervical fusion (PCF) constructs stopping at C7, T1, and T2 under cyclic load to determine the range of motion (ROM) between the lowest instrumented level and lowest instrumented-adjacent level (LIV-1).Summary of Background Data: PCF is a mainstay of treatment for various cervical spine conditions. The transition between the flexible cervical spine and rigid thoracic spine can lead to construct failure at the cervicothoracic junction. There is little evidence to determine the most appropriate level at which to stop a multilevel PCF.Methods: Fifteen human cadaveric cervicothoracic spines were randomly assigned to 1 of 3 treatment groups: PCF stopping at C7, T1, or T2. Specimens were tested in their native state, following a simulated PCF, and after cyclic loading. Specimens were loaded in flexion-extension), lateral bending, and axial rotation. Three-dimensional kinematics were recorded to evaluate ROM. Results:The C7 group had greater flexion-extension motion than the T1 and T2 groups following instrumentation (10.17 ± 0.83 degree vs. 2.77 ± 1.66 degree and 1.06 ± 0.55 degree, P <0.001), and after cyclic loading (10.42 ± 2.30 degree vs. 2.47 ± 0.64 degree and 1.99 ± 1.23 degree, P < 0.001). There was no significant difference between the T1 and T2 groups. The C7 group had greater lateral bending ROM than both thoracic groups after instrumentation (8.81 ± 3.44 degree vs. 3.51 ± 2.52 degree, P = 0.013 and 1.99 ± 1.99 degree, P = 0.003) and after cyclic loading. The C7 group had greater axial rotation motion than the thoracic groups (4.46 ± 2.27 degree vs. 1.26 ± 0.69 degree, P = 0.010; and 0.73 ± 0.74 degree, P = 0.003) following cyclic loading.Conclusion: Motion at the cervicothoracic junction is significantly greater when a multilevel PCF stops at C7 rather than T1 or T2. This is likely attributable to the transition from a flexible cervical spine to a rigid thoracic spine. Although this does not account for in vivo fusion, surgeons should consider extending multilevel PCF constructs to T1 when feasible.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Murphy¹,

Colantonio²,

et al. 2023

Clinical Spine Surgery: A Spine Publication

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show abstract

“…Whereas clinical issues support anterior surgery regarding decompression of the spinal cord, a minor surgical trauma and fusion ability, biomechanical studies showed better stability for posterior instrumentation [1,20–24] . Due to biomechanical results 360° treatment seems to offer the best stability [7] …”

Section: Discussionmentioning

confidence: 99%

Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model

et al. 2022

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Background: In case of injuries to the subaxial cervical spine, especially in osteoporotic bone, the question of the most stable operative technique arises. There are several techniques of screw fixation available regarding dorsal stabilization. This study investigates 2 techniques (lateral mass screws (LMS) vs cervical pedicle screws (CPS)) in the subaxial cervical spine regarding primary stability in a biomechanical testing using a translational injury model.Methods: A total of 10 human formalin fixed and 10 human fresh-frozen specimens (C 4 -T 1) were investigated. Specimens were randomized in 2 groups. Fracture generation of a luxation injury between C 5 and C 6 was created by a transection of all ligamentous structures as well as the intervertebral disc and a resection of the facet joints.Dorsal stabilization of C 4/C 5 to C 6/C 7 was performed in group A by lateral mass screws, in group B by pedicle screws. In the biomechanical testing, the specimens were loaded at 2 N/s in translation direction until implant failure.Results: Formalin fixed specimen: Mean load failure was 513.8 (±86.74) Newton (N) for group A (LMS) and 570.4 (±156.5) N for group B (CPS). There was no significant difference (P = .6905).Fresh frozen specimen: Mean load failure was 402.3 (±96.4) N for group A (LMS) and 500.7 (±190.3) N for group B (CPS). There was no significant difference (P = .4206). Conclusion:In our loading model respecting the translational injury pattern and a flexion movement we could not verify statistically significant differences between lateral mass screws and cervical pedicle screws. Mean loading failure was slightly higher in the CPS group though.Abbreviations: BMD = bone mineral density, CPS = cervical pedicle screws, CT = computed tomography, DXA = dual-energy Xray absorptiometry, LMS = lateral mass screws, N = Newton.

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“…Using shorter constructs might decrease motion restriction. Cervical pedicle screws have been shown to offer biomechanic advantages [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

CT-Navigated Percutaneous Posterior Positioning of Pedicle Screws in The Cervical Spine

Keil

Kreinest

Grützner

et al. 2022

Preprint

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Background To evaluate reliability, practicability and precision of a novel intraoperative computed tomography(iCT)-based (Airo mobile CT scanner, Brainlab, Munich, Germany) navigated procedure to minimally-invasive positioning of cervical pedicle screws.Methods Ten consecutive patients that suffered from a cervical traumatic instability needing posterior fixation were included in this retrospective analysis. Posterior pedicle screws were positioned iCT-navigated percutaneously. After positioning of the screws, a control scan was performed to assess screw placement and correction if needed. All CT scans were randomly evaluated by two investigators with experience in skeletal CT diagnostics. In the iCT scans, positioning of the screws regarding affection of the medial pedicle cortex as well as the neuroforamina were measured. Additionally, image quality was evaluated with a subjective Likert-Scale (0-5) and a semi-objective Assessability score (0-4).Results 44 screws were placed in an average duration of surgery of 139min [83-209]. The average subjective image quality was 3.9 [2-5], the average assessability score was 3.7 [2-4]. 27 screws (61%) were positioned exactly centered in the pedicle. 4 screws perforated the medial wall by more than 2mm [2.8-2.9]. 9 screws were positioned laterally by more than 2mm [2.5-4.9]. No postoperative neurological deficits were observed.Conclusion iCT-navigated percutaneous placement of pedicle screws is a rather safe and reliable method for posterior fixation of the cervical spine that allows fixation of traumatic cervical instabilities with minimal additional trauma. Even in shallow anatomic structures, visualization of instruments and implants allows for minimally invasive surgery.

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Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? An in vitro biomechanical study

Cited by 18 publications

References 48 publications

Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Biomechanical Analysis of Multilevel Posterior Cervical Spinal Fusion Constructs

Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model

CT-Navigated Percutaneous Posterior Positioning of Pedicle Screws in The Cervical Spine

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