The Effect of Rod Pattern, Outrigger, and Multiple Screw-Rod Constructs for Surgical Stabilization of the 3-Column Destabilized Cervical Spine - A Biomechanical Analysis and Introduction of a Novel Technique

Neurospine

Sebastian Hartmann¹  Anto Abramovic¹  Sara Lener¹  Claudius Thomé¹  Heiko Koller²  Juliane Koller³  Werner Schmoelz⁴ 

[1] Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria;Department of Neurosurgery, Rechts der Isar, Technische Universität München, Germany;Department of Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany;Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria;

关键词: biomechanical study;    cervical spine;    construct testing;    instrumentation patterns;    multilevel constructs;    three-column instability;   

DOI  :  10.14245/ns.2040436.218

来源: DOAJ

【 摘 要 】

Objective Anterior-only reconstructions for cervical multilevel corpectomies are prone to fail under continuous mechanical loading. This study sought to define the mechanical characteristics of different constructs in reducing a range of motion (ROM) of the 3-column destabilized cervical spine, including posterior cobalt-chromium (CoCr)-rods, outrigger-rods (OGR), and a novel triple rod construct using lamina screws (6S3R). The clinical implications of biomechanical findings are discussed in depth from the perspective of the challenges surgeons face cervical deformity correction. Methods Three-column deficient cervical spinal models were produced based on reconstructed computed tomography scans. The corpectomy defect between C3 and C7 end-level vertebrae was restored with anterior titanium (Ti) mesh-cage. The ROM was evaluated in a customized 6-degree of freedom spine tester. Tests were performed with different rod materials (Ti vs. CoCr), varying diameter rods (3.5 mm vs. 4.0 mm), with and without anterior plating, and using different construct patterns: bilateral rod fixation (standard-group), OGR-group, and 6S3R-Group. Construct stability was expressed in changes and differences of ROM (°). Results The largest reduction of ROM was noticed in the 6S3R-group compared to the standard- and the OGR-group. All differences observed were emphasized with an increasing number of corpectomy levels and if anterior plating was not added. For all simulated 1-, 2-, and 3-level corpectomy constructs, the OGR-group revealed decreased ROM for all motion directions compared to the standard-group. An increase of construct stiffness was also recorded for increased rod diameter (4.0 mm) and stiffer rod material (CoCr), though these effects lacked behind the more advanced construct pattern. Conclusion A novel reconstructive technique, the 6S3R-construct, was shown to outperform all other constructs and might resemble a new standard of reference for advanced posterior fixation.

【 授权许可】

Unknown