Abstract
Study Design
Clinically related experimental study.
Objective
Evaluation of strain in posterior low lumbar and spinopelvic instrumentation for multilevel fusion resulting from the impact of such mechanical factors as physiologic motion, different combinations of posterior and anterior instrumentation, and different techniques of interbody device implantation.
Summary of Background Data
Currently different combinations of posterior and anterior instrumentation as well as surgical techniques are used for multilevel lumbar fusion. Their impact on risk of device failure has not been well studied. Strain is a well-known predictor of metal fatigue and breakage measurable in experimental conditions.
Methods
Twelve human lumbar spine cadaveric specimens were tested. Following surgical methods of lumbar pedicle screw fixation (L2–S1) with and without spinopelvic fixation by iliac bolt (SFIB) were experimentally modeled: posterior (PLF); transforaminal (TLIF); and a combination of posterior and anterior interbody instrumentation (ALIF+PLF) with and without anterior supplemental fixation by anterior plate or diverging screws through an integrated plate. Strain was defined at the S1 screws, L5–S1 segment of posterior rods, and iliac bolt connectors; measurement was performed during flexion, extension, and axial rotation in physiological range of motion and applied force.
Results
The highest strain was observed in the S1 screws and iliac bolt connectors specifically during rotation. The S1 screw strain was lower in ALIF+PLF during sagittal motion but not rotation. Supplemental anterior fixation in ALIF+PLF diminished the S1 strain during extension. Strain in the posterior rods was higher after TLIF and PLF and was increased by SFIB; this strain was lowest after ALIF+PLF, as supplemental anterior fixation diminished the strain during extension, in particular, cages with anterior screws more than anterior plate. Strain in the iliac bolt connectors was mainly determined by direction of motion.
Conclusions
Different devices modify strain in low posterior instrumentation, which is higher after transforaminal and posterior techniques, specifically with spinopelvic fixation.
Level of Evidence
N/A.
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CJK (reports grants from DePuy/Synthes Inc, during the conduct of the study; grants from Medtronic Sofamor-Danek, grants from Aesculap, grants from SI Bone, grants from Vertiflex, grants and personal fees from Medicrea, grants from Orthofix, grants from Integra Life Sciences Corporation, grants from Pfizer, grants from Spinal Kinetics, grants from MTF, grants from National Institutes of Health, grants from Globus, outside the submitted work); DI (reports grants from DePuy/Synthes Inc, during the conduct of the study); EML (reports grants from DePuy/Synthes Inc, during the conduct of the study; grants from Medtronic, grants from SI Bone, outside the submitted work); AN (reports grants from Synthes, during the conduct of the study); VVP (reports grants from Synthes, during the conduct of the study; grants from Aesculap, grants from Stryker, grants from SI Bone, grants from National Institutes of Health, grants from Medtronic, grants from Musculoskeletal Transplant Foundation, outside the submitted work); CB (reports grants from DePuy/Synthes Inc, during the conduct of the study); TB (reports grants from DePuy/Synthes Inc, during the conduct of the study; grants from Stryker Endoscopy, SMV Scientific, and Acumed outside the submitted work); CMJC (reports grants from DePuy/Synthes Inc, during the conduct of the study; personal fees from DePuy/Synthes Inc, grants from Medtronic, grants from Aesculap, grants from Medicrea, grants from Vertiflex, grants from AOSpine, outside the submitted work); ELB (reports grants from Synthes, during the conduct of the study; grants from Medtronic, grants from Aesculap, grants from SI Bone, grants from Vertiflex, grants from Medicrea, grants from Synthes, grants from Orthofix, grants from Integra LifeSciences, grants from Anschutz Foundation, grants from OREF, grants from OMeGA, from null, from null, outside the submitted work).
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Kleck, C.J., Illing, D., Lindley, E.M. et al. Strain in Posterior Instrumentation Resulted by Different Combinations of Posterior and Anterior Devices for Long Spine Fusion Constructs. Spine Deform 5, 27–36 (2017). https://doi.org/10.1016/j.jspd.2016.09.045
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DOI: https://doi.org/10.1016/j.jspd.2016.09.045