Should We Cross the Cross-links?

Kulkarni, Arvind G; Dhruv, Abhilash; Bassi, Anupreet

doi:10.1097/brs.0b013e31829af99f

Cited by 24 publications

(19 citation statements)

References 38 publications

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“…Exclusion of TCs will significantly bring down the overall costs when extrapolated to a larger population. 24 The findings of this clinical study are in agreement with those of Wood et al 8 with pedicle screws in adolescent idiopathic scoliosis (377 cross-link and 123 noncross-link), the authors found similar complication rates in both groups with similar SRS-22r scores throughout follow-up.…”

Section: Discussionsupporting

confidence: 82%

Do we need Transverse Connectors to maintain Derotation in Scoliosis Constructs?

Kulkarni¹,

Kantharajanna²,

Dhruv³

et al. 2017

The Journal of Spinal Surgery

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Section: Discussionsupporting

confidence: 82%

Do we need Transverse Connectors to maintain Derotation in Scoliosis Constructs?

Kulkarni¹,

Kantharajanna²,

Dhruv³

et al. 2017

The Journal of Spinal Surgery

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“…This methodology would now seem unethical, as CT scans are now thought to contribute to as many as 1.5% to 2% of all adult cancers [7]. Other methods utilize various anatomic landmarks and calculated relationships within the vertebra [2, 4, 6, 8, 12, 14, 19, 22, 28, 30-32, 35, 40], but these techniques [24] including the Nash-Moe are limited by the fact that the important landmarks are obscured after surgery by pedicle screws and other hardware [25]. Only one method [39] to our knowledge uses pedicle screw orientation to estimate rotation.…”

Section: Introductionmentioning

confidence: 99%

Maintenance of Derotation in Adolescent Idiopathic Scoliosis: a Novel Technique Measuring Postoperative Vertebral Rotation by Pedicle Screw Position

et al. 2015

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Background: Current methods of measuring vertebral rotation by plain radiographs rely on anatomic landmarks that are not present in the postoperative spine or require advanced imaging. Furthermore, there are few studies on the incidence of crankshaft with modern pedicle instrumentation. Questions/Purposes: We sought to (1) describe and validate a method of vertebral rotation measurement using plain radiographs and (2) measure postoperative rotation in a series of patients treated for adolescent idiopathic scoliosis. Methods: Patients with adolescent idiopathic scoliosis treated with surgery over a 6-year period were reviewed. Patients with computed tomography (CT) scans and radiographs within 60 days of another were included. Vertebral rotation was calculated by radiographic measurements and measured directly by CT scan. As an internal control, patients with two apical pedicle screws on all radiographs were analyzed. Rotation was measured for all patients with at least 1 year of radiographic follow-up. Results: Three thousand five hundred fifty-two instrumented spinal levels in 308 consecutive patients were reviewed. Ten patients with 93 screws were analyzed by CT and radiographs. The average discrepancy between computed tomography (CT) and radiographs was 3.3±1.9°, with 81.7% (76/93) within 5°. Intra-and inter-rater reliabilities for measured axial rotation were excellent (intra-class correlation coefficient (ICC)=0.879 and 0.900, respectively). One hundred swventy-eight patients were eligible with an average followup of 2.3±1.2 years; 84.8% (151/178) had screw(s) visible on all images at the major curve apex. The average postsurgical rotation was 3.5±2.9°; 19.2% (29/151) were measured to have a rotation over 5°, and 4.0% (6/151) demonstrated a rotation over 10°. Only 4.6% (7/151) of patients demonstrated a postoperative Cobb angle change over 10°. Conclusions: Most major curves have apical pedicle screw instrumentation that can be followed by radiographs alone to measure rotation. Vertebral rotation measurement requires only plain radiographs and is a more sensitive determination for subtle postoperative crankshaft than change in Cobb angle.

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“…Eliminating crosslinks reduces the operative time as well as the overall cost. Prominence of implants, corrosion, infection, implant failure, and pseudarthrosis are complications attributed to crosslinks in the literature, which can be avoided by preventing their incorporation into spinal constructs [35, 36].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis

Ouyang

Wang

Vaudreuil

et al. 2019

Journal of Healthcare Engineering

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Early-onset scoliosis (EOS) remains a challenging condition for which current nonfusion surgeries require iterative lengthening surgeries. A growing rod with sliding pedicle screw system (GRSPSS) was developed to treat spinal deformities without repeated operative lengthening. This study was performed to evaluate whether GRSPSS had similar stability as a conventional pedicle screw system to maintain deformity correction. A serial-linkage robotic manipulator with a six-axis load cell positioned on the end-effector was utilized to evaluate the mechanical stability of the GRSPSS versus conventional fixed scoliosis instrumentation. Ten skeletally mature thoracic female Katahdin sheep spines (T4-L1) were subjected to 2.5 Nm of flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in 2° increments for each state. The overall range of motion (ROM), apical segment ROM, and stiffness were calculated and reported. A two-tailed paired t-test was used to detect significant differences (p<0.05) between the fixed group and GRSPSS fixation. There were no significant differences in overall range of motion (ROM), apical segment ROM, or stiffness for FE or LB between the GRSPSS group and fixed group. In AR, the GRSPSS group showed increased ROM compared to the fixed group for the overall spine (36.0° versus 19.2°, p<0.01) and for the instrumented T8-T10 segments (7.0° versus 2.9°, p=0.02). Similarly, the fixed rod elastic zone (EZ) stiffness was significantly greater than the GRSPSS EZ stiffness (0.29 N/m versus 0.17 N/m, p<0.001). The space around the rod allows for the increased AR observed with the GRSPSS fusion technique and is necessary for axial growth. The GRSPSS fusion model shows equivalent flexion and LB stability to current fusion models and represents a stable fusion technique and may allow for longitudinal growth during childhood.

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Should We Cross the Cross-links?

Abstract: N/A.

Cited by 24 publications

References 38 publications

Do we need Transverse Connectors to maintain Derotation in Scoliosis Constructs?

Do we need Transverse Connectors to maintain Derotation in Scoliosis Constructs?

Maintenance of Derotation in Adolescent Idiopathic Scoliosis: a Novel Technique Measuring Postoperative Vertebral Rotation by Pedicle Screw Position

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis

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