Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation

Ntilikina, Yves; Charles, Yann Philippe; Persohn, Sylvain; Skalli, Wafa

doi:10.1007/s00586-020-06594-2

Cited by 12 publications

(5 citation statements)

References 49 publications

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“…When comparing interbody fusion with pedicle screw fixation to pedicle screw fixation alone, the literature also provides heterogenous findings. Whereas Godzik et al [19] found a trend to motion decrease with the use of interbody fusion, the results of Ntilikina et al [21] show a non-significant trend toward motion increase in FE, LB, and AR in comparison to pedicle screw instrumentation alone. Our study confirms that neither bl-PLIF nor TLIF lead to The posterior access route to interbody cage insertion does necessarily mean a destabilizing harm to the segment because of the focal resection of anulus fibrosus and discectomy as well as partial or full facetectomy.…”

Section: Discussionmentioning

confidence: 93%

Residual motion of different posterior instrumentation and interbody fusion constructs

et al. 2023

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Purpose To elucidate residual motion of cortical screw (CS) and pedicle screw (PS) constructs with unilateral posterior lumbar interbody fusion (ul-PLIF), bilateral PLIF (bl-PLIF), facet-sparing transforaminal lumbar interbody fusion (fs-TLIF), and facet-resecting TLIF (fr-TLIF). Methods A total of 35 human cadaver lumbar segments were instrumented with PS (n = 18) and CS (n = 17). Range of motion (ROM) and relative ROM changes were recorded in flexion/extension (FE), lateral bending (LB), axial rotation (AR), lateral shear (LS), anterior shear (AS), and axial compression (AC) in five instrumentational states: without interbody fusion (wo-IF), ul-PLIF, bl-PLIF, fs-TLIF, and fr-TLIF. Results Whereas FE, LB, AR, and AC noticeably differed between the instrumentational states, AS and LS were less prominently affected. Compared to wo-IF, ul-PLIF caused a significant increase in ROM with PS (FE + 42%, LB + 24%, AR + 34%, and AC + 77%), however, such changes were non-significant with CS. ROM was similar between wo-IF and all other interbody fusion techniques. Insertion of a second PLIF (bl-PLIF) significantly decreased ROM with CS (FE -17%, LB -26%, AR -20%, AC -51%) and PS (FE − 23%, LB − 14%, AR − 20%, AC − 45%,). Facet removal in TLIF significantly increased ROM with CS (FE + 6%, LB + 9%, AR + 17%, AC of + 23%) and PS (FE + 7%, AR + 12%, AC + 13%). Conclusion bl-PLIF and TLIF show similarly low residual motion in both PS and CS constructs, but ul-PLIF results in increased motion. The fs-TLIF technique is able to further decrease motion compared to fr-TLIF in both the CS and PS constructs.

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Section: Discussionmentioning

confidence: 93%

Residual motion of different posterior instrumentation and interbody fusion constructs

et al. 2023

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“…Therefore, advanced SPF technique by multiple pelvic screws or multirod construct was tried to solve this problem. Cadaveric studies have shown that four-rod constructs could significantly reduce the flexibility and motion of LSJ in FL, EX, and AR ( Kelly et al, 2008 ; Wang et al, 2013 ; Godzik et al, 2019 ; Ntilikina et al, 2020 ). Consistent with previous studies, the current study additionally indicated that both the multiple pelvic screws and multirod construct could decrease the ROM of LSJ in FL, EX, LB, and AR compared with the SS-SR model.…”

Section: Discussionmentioning

confidence: 99%

“…The four rods crossing the LSJ are more mechanically independent, similar to two separate spinal constructs, providing the majority of cantilever force ( Ramey et al, 2021 ). Cadaveric studies by Ntilikina et al (2020) and Godzik et al (2019) reported that accessory rods connected by domino connector could significantly decrease the strain of primary rods in FL, EX, LB, and the strain of S1-PS in AR. Nevertheless, the protective effect of accessory rods connected by multiple pelvic screws is still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…The ROM of each lumbar segment and SIJ in this intact FE model was compared to the data in several in vitro studies under equivalent loading conditions ( Panjabi et al, 1994 ; Lindsey et al, 2014 ; Cook et al, 2015 ; Cross et al, 2018 ; Ntilikina et al, 2020 ; Sayed et al, 2021 ). For the validation of ROM of each lumbar segment, the S1 was constrained, and pure moments of 7.5 Nm in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were applied to the superior endplate (SEP) of L1.…”

Section: Methodsmentioning

confidence: 99%

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Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Yang

Pan

Hai

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Posterior long spinal fusion was the common procedure for adult spinal deformity (ASD). Although the application of sacropelvic fixation (SPF), the incidence of pseudoarthrosis and implant failure is still high in long spinal fusion extending to lumbosacral junction (LSJ). To address these mechanical complications, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended. This was the first study to compare the biomechanical performance of combining multiple pelvic screws and multirod construct to other advanced SPF constructs for the augmentation of LSJ in long spinal fusion surgery through finite element (FE) analysis.Methods: An intact lumbopelvic FE model based on computed tomography images of a healthy adult male volunteer was constructed and validated. The intact model was modified to develop five instrumented models, all of which had bilateral pedicle screw (PS) fixation from L1 to S1 with posterior lumbar interbody fusion and different SPF constructs, including No-SPF, bilateral single S2-alar-iliac (S2AI) screw and single rod (SS-SR), bilateral multiple S2AI screws and single rod (MS-SR), bilateral single S2AI screw and multiple rods (SS-MR), and bilateral multiple S2AI screws and multiple rods (MS-MR). The range of motion (ROM) and stress on instrumentation, cages, sacrum, and S1 superior endplate (SEP) in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were compared among models.Results: Compared with intact model and No-SPF, the ROM of global lumbopelvis, LSJ, and sacroiliac joint (SIJ) was decreased in SS-SR, MS-SR, SS-MR, and MS-MR in all directions. Compared with SS-SR, the ROM of global lumbopelvis and LSJ of MS-SR, SS-MR, and MS-MR further decreased, while the ROM of SIJ was only decreased in MS-SR and MS-MR. The stress on instrumentation, cages, S1-SEP, and sacrum decreased in SS-SR, compared with no-SPF. Compared with SS-SR, the stress in EX and AR further decreased in SS-MR and MS-SR. The most significantly decreased ROM and stress were observed in MS-MR.Conclusion: Both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ and reduce stress on instrumentation, cages, S1-SEP, and sacrum. The MS-MR construct was the most adequate to reduce the risk of lumbosacral pseudarthrosis, implant failure, and sacrum fracture. This study may provide surgeons with important evidence for the application of MS-MR construct in the clinical settings.

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“…The fixation strengths of TT, SEPST, and DEPST were compared using the vertebral motion angle when the 7.5 Nm moment was applied to the center of the L1 lower endplate of the caudal vertebra, which was the same strength as in previous reports that compared the fixation strength of screws [19][20][21].…”

Section: ) Comparison Of the Vertebral Motion Anglementioning

confidence: 99%

Comparison of the Fixation Strengths of Screws between the Traditional Trajectory and the Single and Double Endplate Penetrating Screw Trajectories Using Osteoporotic Vertebral Body Models Based on the Finite Element Method

Takeuchi,

Takamizawa,

Konishi

et al. 2024

Asian Spine J

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Study Design: This is a finite element (FE) study.Purpose: To compare the fixation strength of traditional trajectory (TT) and single and double endplate penetrating screw trajectories (SEPST/DEPST) to the osteoporotic vertebral body model based on the FE method.Overview of Literature: SEPST/DEPST have been developed to enhance the fixation strength in patients with diffuse idiopathic hyperostosis (DISH). This technique was also applied to patients with osteoporosis. However, determining the superiority of SEPST/ DEPST is difficult because of the heterogeneous patient backgrounds.Methods: Twenty vertebrae (T12 and L1) from 10 patients with osteoporosis (two males and eight females; mean age, 74.7 years) were obtained to create the 10 FE models. First, a single screw was placed with TT and SEPST/DEPST, and the fixation strength was compared by axial pullout strength (POS) and multidirectional loading tests. Second, two screws were placed on the bilateral pedicles with TT and SEPST/DEPST, and the fixation force of the vertebrae in the constructs in flexion, extension, lateral flexion, and axial rotation was examined.Results: SEPST and DEPST had 140% and 171% higher POS values than TT, respectively, and the DEPST result was statistically significant (p =0.007). The multidirectional fixation strength was significantly higher in DEPST and SEPST than in TT in the cranial, caudal, and medial directions (p <0.05) but not in the lateral direction (p =0.05). The vertebral fracture strength at the lower instrumented vertebra of the DEPST tended to be higher than that of TT. The vertebral motion angles in SEPST and DEPST were significantly smaller in lateral bending (p =0.02) and tended to be smaller in flexion and extension than in TT (p =0.13).Conclusions: This study may provide useful information for spine surgeons in deciding whether to choose the SEPS or DEPS technique for augmenting fixation in osteoporotic vertebral fracture surgery.

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Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation

Cited by 12 publications

References 49 publications

Residual motion of different posterior instrumentation and interbody fusion constructs

Residual motion of different posterior instrumentation and interbody fusion constructs

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Comparison of the Fixation Strengths of Screws between the Traditional Trajectory and the Single and Double Endplate Penetrating Screw Trajectories Using Osteoporotic Vertebral Body Models Based on the Finite Element Method

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