Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

Li, Cheng; Wang, Jian Jie; Zeng, Zhi Li; Zhu, Rui; Yu, Yan; Li, Chunbo; Wu, Zhou Rui

doi:10.1002/14651858.cd009073

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…3,8,15 Low bone mineral density (BMD) in patients presents a challenge because poor bone quality can severely compromise the maximum achievable purchase of the screws. Laboratory investigations have consistently shown that osteoporotic vertebrae demonstrate reduced insertion torque and pullout strength.…”

mentioning

confidence: 99%

Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase

Wray¹,

Mimran

Vadapalli

et al. 2015

SPI

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OBJECT Low bone mineral density in patients undergoing lumbar spinal surgery with screws is an especially difficult challenge because poor bone quality can severely compromise the maximum achievable purchase of the screws. A relatively new technique, the cortical bone screw trajectory, utilizes a medialized trajectory in the caudocephalad direction to engage a greater amount of cortical bone within the pars interarticularis and pedicle. The objectives of this cadaveric biomechanical study were to 1) evaluate a cortical screw system and compare its mechanical performance to the traditional pedicle screw system; 2) determine differences in bone quality associated with the cortical screw trajectory versus the normal pedicle screw insertion technique; 3) determine the cortical wall breach rate with both the cortical and traditional screw trajectories; and 4) determine the performance of the traditional screw in the cortical screw trajectory. METHODS Fourteen fresh frozen human lumbar spine sections (L1–5) were used in this study (mean age 57 ± 19 years). The experimental plan involved drilling and tapping screw holes for 2 trajectories under navigation (a traditional pedicle screw and a cortical screw) in both high-and low-quality vertebrae, measuring the bone quality associated with these trajectories, placing screws in the trajectories, and evaluating the competence of the screw purchase via 2 mechanical tests (pullout and toggle). The 3 experimental variants were 1) traditional pedicle screws placed in the traditional pedicle screw trajectory, 2) traditional pedicle screws placed in the cortical screw trajectory, and 3) cortical screws placed in the cortical screw trajectory. RESULTS A statistically significant increase in bone quality was observed for the cortical trajectories with a cortical screw (42%; p < 0.001) and traditional pedicle screw (48%; p < 0.001) when compared to the traditional trajectory with a traditional pedicle screw within the high-quality bone group. These significant differences were also found in the lowquality bone cohort. All mechanical parameter comparisons (screw type and trajectory) between high-quality and lowquality samples were significant (p < 0.01), and these data were all linearly correlated (r ≥ 0.65) to bone mineral density. Not all mechanical parameters determined from pullout and toggle testing were statistically significant between the 3 screw/trajectory combinations. The incidence of cortical wall breach with the cortical or traditional pedicle screw trajectories was not significantly different. CONCLUSIONS The data demonstrated that the cortical trajectory provides denser bone that allows for utilization of smaller screws to obtain mechanical purchase that is equivalent to long pedicle screws placed in traditional pedicle screw trajectories for both normal- and low-quality bone. Overall, this biomechanical study in cadavers provides evidence that the cortical screw trajectory represents a good option to obtain fixation for the lumbar spine with low-quality bone.

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mentioning

confidence: 99%

Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase

Wray¹,

Mimran

Vadapalli

et al. 2015

SPI

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“…7 Despite several constructs including short segment fixation, long segment fixation and mono-segment instrumentation (with or without bone grafting), the lack of high-quality evidence precludes the superiority of one method over the others. 8 Though short segment instrumentation has the advantages of preservation of motion segments, lesser tissue morbidity and shorter operative times, long term results show loss of correction and implant failures. [9][10][11] To counter this failure, various methods proposed include anterior stabilization, strut grafting, transpedicular bone grafting, placement of body augmenter and cement augmentation of vertebrae.…”

Section: Introductionmentioning

confidence: 99%

Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome?

Mohammed

Carrasco

Verma

et al. 2021

Global Spine Journal

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Study Design: Retrospective comparative study. Objectives: To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). Methods: 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. Results: Back pain score was significantly lower in the FL group ( P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb’s angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay. Conclusion: The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.

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“…Pedicle screws are the most frequently used implant in spine surgery – as well in traumatic as in degenerative, infectious or tumour indications 1 . These screws are positioned pairwise through a posterior approach and screws of multiple levels can be connected by rods 2 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation

Keil

Luxenhofer

Vetter

et al. 2020

Robotics Computer Surgery

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Background This study evaluates image quality of a new flat‐panel three‐dimensional (3D) C‐arm to the current generation and to intraoperative and stationary computed tomography (CT) in spinal surgery. Methods Three‐dimensional‐imaging of 44 posterior screws acquired with two generations of 3D C‐arms (Arcadis Orbic, AO and Cios Spin, CS, Siemens, Germany) and CT scans (mobile intraoperative CT Airo, iCT, Brainlab, Germany and stationary CT Aquilion 32, sCT, Toshiba, Japan) were performed. Evaluation regarded assessability and measurements of implant position. Results Assessability score was 0.11 in AO, 0.56 in sCT, 0.91 in iCT and 1.46 in CS (p < 0.0005). AO and CS showed a significant difference in accuracy (p = 0.001) as well as CS and iCT (p < 0.001). Measurements of protrusion over the anterior edge did not show a significant difference (p = 0.341). Conclusions Image quality of the new generation of flat‐panel 3D C‐arms competes with CT imaging and offers significant advantages compared to the former generation.

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Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

Cited by 10 publications

References 16 publications

Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase

Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase

Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome?

Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation

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