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

Sebastian Hartmann; Claudius Thomé; Anto Abramovic; Sara Lener; Werner Schmoelz; Juliane Koller; Heiko Koller

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자료유형: 학술저널

저자정보: Sebastian Hartmann (Medical University of Innsbruck) Claudius Thomé (Medical University of Innsbruck) Anto Abramovic (Medical University of Innsbruck) Sara Lener (Medical University of Innsbruck) Werner Schmoelz (Medical University of Innsbruck) Juliane Koller (Schoen Clinic Vogtareuth) Heiko Koller (Technical University of Munich)

저널정보: 대한척추신경외과학회 Neurospine 대한척추신경외과학회지 제17권 제3호

발행연도: 2020.1

수록면: 610 - 629 (20page)

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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), OGRgroup, 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.

#Biomechanical study #Cervical spine #Construct testing #Instrumentation patterns #Multilevel constructs #Three-column instability

참고문헌 (60)

참고문헌 신청

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Vaccaro AR / 1998 / Early failure of long segment anterior cervical plate fixation / J Spinal Disord 11:410~415

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Hartmann S / 2015 / Biomechanical testing of circumferential instrumentation after cervical multilevel corpectomy / Eur Spine J 24:2788~2798

Koller H / 2015 / Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing : biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw-plate fixation technique / Eur Spine J 24:2848~2856