Mechanical Comparison of Posterior Instrumentation Constructs for Spinal Fixation Across the Cervicothoracic Junction

Tatsumi, Robert L.; Yoo, Jung U.; Liu, Qi; Hart, Robert A.

doi:10.1097/01.brs.0000261490.90956.2b

Cited by 21 publications

(9 citation statements)

References 33 publications

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“…On biomechanical testing, there is no difference between the dual-diameter and solid domino connected rod. 26 In our series, the fixation failure rate was 6% when using a PSS and 15% when using a SHRS. The safety and ease of screw placement with comparable rates of failure make this the preferred method of fixation at the CTJ.…”

Section: Discussionmentioning

confidence: 91%

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Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Placantonakis

Laufer

Wang³

et al. 2008

SPI

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Object In this retrospective analysis the authors describe the assessment and outcomes of 90 patients who underwent placement of posterior instrumentation at the cervicothoracic junction following the resection of a primary or metastatic tumor during a 10-year period. Methods All patients underwent a posterolateral laminectomy including uni- or bilateral facetectomy, and 44 patients additionally required vertebral body resection and reconstruction. In patients who underwent C-6 or C-7 decompression, the posterior instrumentation strategies changed from the use of lateral mass plate systems (LMPSs) to lateral mass screw/rod systems (LMSRSs). Similarly, for T1–3 tumor decompression, the strategy shifted from sublaminar hook/rod systems (SHRSs) to the use of pedicle screw systems (PSSs) in which the surgeon used either a 6.25-mm rod or dual-diameter rods with or without a connector. Results The overall surgical complication rate was 19% including fixation failure in 11 patients (12%), 6 of whom required reoperation. Fixation failure rates for cervical decompression decreased from 2 (29%) of 7 patients in the LMPS group to 0 (0%) of 8 in the LMSRS group (p = 0.2). The fixation failure rates for thoracic decompression were 7 (15%) of 48 patients in the SHRS group, and there was a decrease to 2 (7%) of 27 in the PSS group (p = 0.48). Neurological and functional outcomes including American Spinal Injury Association, Eastern Cooperative Oncology Group, and Medical Research Council muscle strength and pain scores remained stable or improved in 94, 96, 100, and 96% of patients, respectively. Conclusions Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors.

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Section: Discussionmentioning

confidence: 91%

“…No patient in our series experienced screw or rod breakage, despite biomechanical data suggesting that this construct is inferior across the CTJ compared with dual-rod systems. 26 Thus, in tumor patients undergoing C6-7 decompression, a 3.5-mm screw/rod system provides reliable fixation.…”

Section: Discussionmentioning

confidence: 99%

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Placantonakis

Laufer

Wang³

et al. 2008

SPI

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“…The weakest of construct involved and C6/7, then supplemented with posterior fixation using bilateral lateral mass screws at C5 and C6, and bilateral C7 laminar screws (28 and 32 mm). paired 3.5 mm diameter rods, which was shown to be inferior to paired 3.5 mm/5.5 mm transitional rods, as well as paired 3.5 and 5.5 mm rods joined with solid or hinged domino connectors (33). However, Yang et al showed increased complication rates, blood loss and operating time associated with transitional rods over small rods, with nonetheless similar pseudoarthrosis rates (34).…”

Section: Resultsmentioning

confidence: 99%

C7 intra-laminar screws for complex cervicothoracic spine surgery—a case series

Wilson¹,

Selby

2017

J. Spine Surg.

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“…As a transition zone from the flexible, lordotic cervical spine to the rigid thoracic spine, the cervicothoracic junction is subjected to force concentration. 30 When significant instability exists, most authors have recommended combined anterior-posterior treatment. 4,14,18 This trend is due in part to the limitations of fixation at the cervicothoracic junction.…”

Section: Introductionmentioning

confidence: 99%

“…A biomechanical study of these four constructs (hinged and fixed domino-connectors separate) has been conducted by Tatsumi et al, 30 They concluded that the construct containing all 3.5-mm screws was the weakest and failed consistently at lower loads. The hinged domino construct failed at the hinge axis which was the weakest link in the construct.…”

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confidence: 99%

Posterior Cervicothoracic Stabilization Using Tapered Rods

Elqazaz¹

2015

Egyptian Spine Journal

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Background Data: The cervicothoracic spine is a junction area with complex biomechanics. A variety of disorders affect this region, rendering it unstable. Numerous posterior constructs have been evaluated. The clinical efficacy of a screwrod system utilizing tapered (dual-diameter) rods in cervicodorsal stabilization is still not evident. Purpose: Our aim is to evaluate the clinical efficacy of dual diameter rods (5.5-3.5mm taper), connecting 3.5-mm cervical lateral mass screws/pedicle screws and 5.5-mm thoracic pedicle screws used to instrument across the cervicothoracic junction for a variety of pathologies. Study Design: A retrospective descriptive clinical case study. Patients and Methods:The authors retrospectively reviewed their archive between February 2011 and February 2015, and ten patients who were operated upon due to cervicothoracic junction pathologies were included. All patients underwent surgical treatment by posterior instrumentation utilizing tapered rods. The cases were periodically followed up. Results: There were six men and four women included in the study, with a mean age of 40 years (range 21-62 years). There were five cases of trauma, two cases of tuberculosis and three cases of spine metastasis. Seven patients experienced marked improvement of their preoperative weakness according to Frankel grades of paraplegia. All patients showed stable cervicodorsal junction with fusion after one year. Three patients suffered postoperative wound infection. Conclusion: Tapered rods are an excellent and a viable option to connect screws to stabilize cervicothoracic junction. (2015ESJ089)

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Mechanical Comparison of Posterior Instrumentation Constructs for Spinal Fixation Across the Cervicothoracic Junction

Cited by 21 publications

References 33 publications

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

C7 intra-laminar screws for complex cervicothoracic spine surgery—a case series

Posterior Cervicothoracic Stabilization Using Tapered Rods

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