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Pokorni AJ, Turbucz M, Kiss RM, Eltes PE, Lazary A. Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study. Sci Rep 2023; 13:18767. [PMID: 37907570 PMCID: PMC10618450 DOI: 10.1038/s41598-023-45736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Total en bloc spondylectomy (TES) effectively treats spinal tumors. The surgery requires a vertebral body replacement (VBR), for which several solutions were developed, whereas the biomechanical differences between these devices still need to be completely understood. This study aimed to compare a femur graft, a polyetheretherketone implant (PEEK-IMP-C), a titan mesh cage (MESH-C), and a polymethylmethacrylate replacement (PMMA-C) using a finite element model of the lumbar spine after a TES of L3. Several biomechanical parameters (rotational stiffness, segmental range of motion (ROM), and von Mises stress) were assessed to compare the VBRs. All models provided adequate initial stability by increasing the rotational stiffness and decreasing the ROM between L2 and L4. The PMMA-C had the highest stiffness for flexion-extension, lateral bending, and axial rotation (215%, 216%, and 170% of intact model), and it had the lowest segmental ROM in the instrumented segment (0.2°, 0.5°, and 0.7°, respectively). Maximum endplate stress was similar for PMMA-C and PEEK-IMP-C but lower for both compared to MESH-C across all loading directions. These results suggest that PMMA-C had similar or better primary spinal stability than other VBRs, which may be related to the larger contact surface and the potential to adapt to the patient's anatomy.
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Affiliation(s)
- Agoston Jakab Pokorni
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Mate Turbucz
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem Rkp. 3., Budapest, 1111, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary.
- Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
| | - Aron Lazary
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
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Surgical fixation of pathologic and traumatic spinal fractures using single position surgery technique in lateral decubitus position. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2212-2219. [PMID: 35122503 DOI: 10.1007/s00586-022-07128-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/15/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Retrospective Case Series. OBJECTIVES This study aims to determine complications, readmission, and revision surgery rates in patients undergoing single position surgery (SPS) for surgical treatment of traumatic and pathologic thoracolumbar fractures. METHODS A multi-center review of patients who underwent SPS in the lateral decubitus position (LSPS) for surgical management of traumatic or pathologic thoracolumbar fractures between January 2016 and May 2020 was conducted. Operative time, estimated blood loss (EBL), intraoperative complications, postoperative complications, readmissions, and revision surgeries were collected. RESULTS A total of 12 patients with a mean age of 45 years (66.67% male) were included. The majority of patients underwent operative treatment for acute thoracolumbar trauma (66.67%) with a mean injury severity score (ISS) of 16.71. Mean operative time was 175.5 min, mean EBL of 816.67 cc. Five patients experienced a complication, two of which required revision surgery for additional decompression during the initial admission. All ambulatory patients were mobilized on postoperative day 1. The mean hospital length of stay (LOS) was 9.67 days. CONCLUSION The results of this case series supports LSPS as a feasible alternative to the traditional combined anterior-posterior approach for surgical treatment of pathologic and thoracolumbar fractures. These results are similar to reductions in operative time, EBL, and LOS seen in the elective spine literature with LSPS. LEVEL OF EVIDENCE IV.
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Preclinical Evaluation of a Novel 3D-Printed Movable Lumbar Vertebral Complex for Replacement: In Vivo and Biomechanical Evaluation of Goat Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2343404. [PMID: 34926682 PMCID: PMC8683181 DOI: 10.1155/2021/2343404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
Purpose This was an in vivo study to develop a novel movable lumbar artificial vertebral complex (MLVC) in a goat model. The purpose of this study was to evaluate clinical and biomechanical characteristics of MLVC and to provide preclinical data for a clinical trial in the future. Methods According to the preoperative X-ray and CT scan data of the lumbar vertebrae, 3D printing of a MLVC was designed and implanted in goats. The animals were randomly divided into three groups: intact, fusion, and nonfusion. In the intact group, only the lumbar vertebrae and intervertebral discs were exposed during surgery. Both the fusion and nonfusion groups underwent resection of the lumbar vertebral body and the adjacent intervertebral disc. Titanium cages and lateral plates were implanted in the fusion group. MLVC was implanted in the nonfusion group. All groups were evaluated by CT scan and micro-CT to observe the spinal fusion and tested using the mechanical tester at 6 months after operation. Results The imaging results showed that with the centrum, the artificial endplates of the titanium cage and MLVC formed compact bone trabeculae. In the in vitro biomechanical test, the average ROM of L3-4 and L4-5 for the nonfusion group was found to be similar to that of the intact group and significantly higher in comparison to that of the fusion group (P < 0.05). The average ROM of flexion, extension, lateral bending, and rotation in the L2-3 intervertebral space significantly increased in the fusion group compared with the intact group and the nonfusion group (P < 0.001). There were no significant differences in flexion, extension, lateral bending, and rotation between the nonfusion and intact groups (P > 0.05). The average ROM of flexion, extension, lateral bending, and rotation in the L2-5 intervertebral space was not significantly different between the intact group, the fusion group, and the nonfusion group, and there was no statistical significance (P > 0.05). HE staining results did not find any metal and polyethylene debris caused by abrasion. Conclusion In vivo MLVC can not only reconstruct the height and stability of the centrum of the operative segment but also retain the movement of the corresponding segment.
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Segi N, Nakashima H, Kanemura T, Satake K, Ito K, Tsushima M, Tanaka S, Ando K, Machino M, Ito S, Yamaguchi H, Koshimizu H, Tomita H, Ouchida J, Morita Y, Imagama S. Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture. J Clin Med 2021; 10:5664. [PMID: 34884365 PMCID: PMC8658075 DOI: 10.3390/jcm10235664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior-posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Yoshinori Morita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
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Analysis of the Curvature and Morphologic Features of the Lumbar Vertebral Endplates Through the Transverse Section: A Radioanatomical Study. World Neurosurg 2021; 150:e500-e510. [PMID: 33744426 DOI: 10.1016/j.wneu.2021.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Knowledge concerning the curvature of the vertebrae through the transverse section is of clinical significance. However, relevant reports are scarce. This study investigated the features based on the cross-sections of lumbar vertebral endplates to provide information for clinical practice. METHODS Computed tomography images of 78 subjects were retrospectively reviewed. The geometric morphometrics was performed, and the curvature of the vertebral endplates was calculated by the self-written MATLAB algorithm. The principal component analysis, the canonical variate analysis, the discriminant function analysis, and the Mann-Whitney U test were performed. Statistical significance was set at P < 0.05. RESULTS No gender difference was found. In contrast, a morphologic difference was found between the superior and inferior lumbar vertebral endplates and between different segments. More specifically, the shape of the endplates gradually changes from the renal shape at superior L1 to the shell-like shape at inferior L5. The mean curvature values of the lateral anterior border were all around 0.60 cm-1, whereas the mean curvature values of the lateral posterior borders range from 0.66 to 1.09 cm-1 from L1 to L5. From L1 to L3, the mean and maximum curvature of the lateral posterior superior vertebral endplates decrease. The trend could also be found on the lateral posterior border of the inferior endplates from L1 to L3. CONCLUSIONS The current study described morphologic variations and curvature of the lumbar vertebral endplates, which have not been reported previously. The different curvature distribution could provide important information for surgeons and manufacturers.
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Liebsch C, Aleinikov V, Kerimbayev T, Akshulakov S, Kocak T, Vogt M, Jansen JU, Wilke HJ. In vitro comparison of personalized 3D printed versus standard expandable titanium vertebral body replacement implants in the mid-thoracic spine using entire rib cage specimens. Clin Biomech (Bristol, Avon) 2020; 78:105070. [PMID: 32531440 DOI: 10.1016/j.clinbiomech.2020.105070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Expandable titanium implants have proven their suitability as vertebral body replacement device in several clinical and biomechanical studies. Potential stabilizing features of personalized 3D printed titanium devices, however, have never been explored. This in vitro study aimed to prove their equivalence regarding primary stability and three-dimensional motion behavior in the mid-thoracic spine including the entire rib cage. METHODS Six fresh frozen human thoracic spine specimens with intact rib cages were loaded with pure moments of 5 Nm while performing optical motion tracking of all vertebrae. Following testing in intact condition (1), the specimens were tested after inserting personalized 3D printed titanium vertebral body replacement implants (2) and the two standard expandable titanium implants Obelisc™ (3) and Synex™ (4), each at T6 level combined with posterior pedicle screw-rod fixation from T4 to T8. FINDINGS No significant differences (P < .05) in primary and secondary T1-T12 ranges of motion were found between the three implant types. Compared to the intact condition, slight decreases of the range of motion were found, which were significant for Synex™ in primary flexion/extension (-17%), specifically at T3-T4 level (-46%), primary lateral bending (-18%), and secondary lateral bending during primary axial rotation (-53%). Range of motion solely increased at T8-T9 level, while being significant only for Obelisc™ (+35%). INTERPRETATION Personalized 3D printed vertebral body replacement implants provide a promising alternative to standard expandable devices regarding primary stability and three-dimensional motion behavior in the mid-thoracic spine due to the stabilizing effect of the rib cage.
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Affiliation(s)
- Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | | | | | | | - Tugrul Kocak
- Department of Orthopedics, Ulm University, Ulm, Germany
| | - Morten Vogt
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Jan Ulrich Jansen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany.
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Adler D, Akbar M, Spicher A, Goerke SA, Schmoelz W. Biomechanical Study of a Novel, Expandable, Non-Metallic and Radiolucent CF/PEEK Vertebral Body Replacement (VBR). MATERIALS 2019; 12:ma12172732. [PMID: 31454960 PMCID: PMC6747954 DOI: 10.3390/ma12172732] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022]
Abstract
Vertebral body replacement is well-established to stabilize vertebral injuries due to trauma or cancer. Spinal implants are mainly manufactured by metallic alloys; which leads to artifacts in radiological diagnostics; as well as in radiotherapy. The purpose of this study was to evaluate the biomechanical data of a novel carbon fiber reinforced polyetheretherketone (CF/PEEK) vertebral body replacement (VBR). Six thoracolumbar specimens were tested in a six degrees of freedom spine tester. In all tested specimens CF/PEEK pedicle screws were used. Two different rods (CF/PEEK versus titanium) with/without cross connectors and two different VBRs (CF/PEEK prototype versus titanium) were tested. In lateral bending and flexion/extension; range of motion (ROM) was significantly reduced in all instrumented states. In axial rotation; the CF/PEEK combination (rods and VBR) resulted in the highest ROM; whereas titanium rods with titanium VBR resulted in the lowest ROM. Two cross connectors reduced ROM in axial rotation for all instrumentations independently of VBR or rod material. All instrumented states in all planes of motion showed a significantly reduced ROM. No significant differences were detected between the VBR materials in all planes of motion. Less rigid CF/PEEK rods in combination with the CF/PEEK VBR without cross connectors showed the smallest reduction in ROM. Independently of VBR and rod material; two cross connectors significantly reduced ROM in axial rotation. Compared to titanium rods; the use of CF/PEEK rods results in higher ROM. The stiffness of rod material has more influence on the ROM than the stiffness of VBR material.
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Affiliation(s)
- Daniel Adler
- Spine Center, Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, Ruprecht-Karls-University Heidelberg, Schlierbacher Landstraße 200A, 69118 Heidelberg, Germany
| | - Michael Akbar
- Spine Center, Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, Ruprecht-Karls-University Heidelberg, Schlierbacher Landstraße 200A, 69118 Heidelberg, Germany.
| | - Anna Spicher
- Department of Trauma Surgery, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Stephanie-Alice Goerke
- Department of Anatomy, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
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Lee CH, Hsu CC, Chaing L. An Optimization Study for the Bone-Implant Interface Performance of Lumbar Vertebral Body Cages Using a Neurogenetic Algorithm and Verification Experiment. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mundis GM, Eastlack RK, Moazzaz P, Turner AWL, Cornwall GB. Contribution of Round vs. Rectangular Expandable Cage Endcaps to Spinal Stability in a Cadaveric Corpectomy Model. Int J Spine Surg 2015; 9:53. [PMID: 26609508 DOI: 10.14444/2053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Expandable cages are gaining popularity in anterior reconstruction of the thoracolumbar spine following corpectomy as they can provide adjustable distraction and deformity correction. Rectangular, rather than circular, endcaps provide increased resistance to subsidence by spanning the apophyseal ring; however their impact on construct stability is not known. The objective of this study was to investigate the contribution of expandable corpectomy cage endcap shape (round vs. rectangular) and fixation method (anterior plate vs. posterior pedicle screws) to the stability of an L1 sub-total corpectomy construct. METHODS Eight fresh-frozen cadaveric specimens (T11-L3) were subjected to multi-directional flexibility testing to 6 N·m with a custom spine simulator. Test conditions were: intact, L1 sub-total corpectomy defect, expandable cage (round endcap) alone, expandable cage (round endcap) with anterior plate, expandable cage (round endcap) with bilateral pedicle screws, expandable cage (rectangular endcap) alone, expandable cage (rectangular endcap) with anterior plate, expandable cage (rectangular endcap) with bilateral pedicle screws. Range-of-motion across T12-L2 was measured with an optoelectronic system. RESULTS The expandable cage alone with either endcap provided significant stability to the corpectomy defect, reducing motion to intact levels in flexion-extension with both endcap types, and in lateral bending with rectangular endcaps. Round endcaps allowed greater motion than intact in lateral bending, and axial rotation ROM was greater than intact for both endcaps. Supplemental fixation provided the most rigid constructs, although there were no significant differences between instrumentation or endcap types. CONCLUSIONS These results suggest anterior-only fixation may be adequate when using an expandable cage in a sub-total corpectomy application and choice of endcap type may be driven by other factors such as subsidence resistance.
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Affiliation(s)
- Gregory M Mundis
- Scripps Clinic Division of Orthopedic Surgery, San Diego, CA ; San Diego Spine Foundation, San Diego, CA
| | - Robert K Eastlack
- Scripps Clinic Division of Orthopedic Surgery, San Diego, CA ; San Diego Spine Foundation, San Diego, CA
| | - Payam Moazzaz
- Orthopaedic Specialists of North County, Tri-City Medical Center Orthopaedic and Spine Institute, Oceanside, CA
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Schnake KJ, Stavridis SI, Kandziora F. Five-year clinical and radiological results of combined anteroposterior stabilization of thoracolumbar fractures. J Neurosurg Spine 2014; 20:497-504. [PMID: 24606000 DOI: 10.3171/2014.1.spine13246] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite promising early clinical results, the long-term outcome of the use of expandable titanium cages to reconstruct the anterior column after traumatic burst fractures is still unknown. The purpose of this prospective study was to assess the clinical and radiological outcomes of the use of expandable titanium cages 5 years postoperatively. METHODS Eighty patients with traumatic thoracolumbar burst fractures (T4-L5) underwent posterior stabilization followed by anterior corpectomy and reconstruction using expandable titanium cages with or without additional anterior plating. After 5 years, fusion was evaluated by means of plain radiographs and CT scans, and the patients' scores on the Oswestry Disability Index (ODI), their neurological status, and clinical results were assessed. RESULTS Forty-five (56%) of the 80 patients could be examined after 5 years. There was a relatively high rate of complications related to thoracotomy (26%), but there were no complications directly related to the cages. Revision surgery was required in 1 case. The average postoperative loss of correction was only 2.4° due to minimal subsidence of the cages. No cage showed a radiolucent line or instability in flexion-extension views. Bony fusion, as assessed by CT scan, was achieved in 41 patients (91%). On clinical examination, 96% of all patients were ambulatory and showed minimal restriction of spinal range of motion; 71% did not need analgesic medication at all; and 67% were able to work. The average ODI score was 12. Thirty-one percent of patients complained of some kind of anterior approach-related complications. CONCLUSIONS Combined anteroposterior stabilization of thoracolumbar burst fractures with expandable titanium cages is a relative safe procedure with satisfactory radiological and clinical long-term outcome. High fusion rates can be achieved, with only minor loss of correction, typically occurring in the 1st year. However, open thoracotomy carries the risks of additional complications and development of post-thoracotomy syndrome.
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Affiliation(s)
- Klaus John Schnake
- Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt, Germany
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