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
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, incl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2020-09-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-2040436-218.pdf |
| _version_ | 1797329816568987648 |
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| author | Sebastian Hartmann Claudius Thomé Anto Abramovic Sara Lener Werner Schmoelz Juliane Koller Heiko Koller |
| author_facet | Sebastian Hartmann Claudius Thomé Anto Abramovic Sara Lener Werner Schmoelz Juliane Koller Heiko Koller |
| author_sort | Sebastian Hartmann |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T07:10:55Z |
| format | Article |
| id | doaj.art-baad8e83da3f490a804ebb4ee6b077d9 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T07:10:55Z |
| publishDate | 2020-09-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-baad8e83da3f490a804ebb4ee6b077d92024-02-03T03:08:01ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912020-09-0117361062910.14245/ns.2040436.2181060The 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 TechniqueSebastian Hartmann0Claudius Thomé1Anto Abramovic2Sara Lener3Werner Schmoelz4Juliane Koller5Heiko Koller6 Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria Department of Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany Department of Neurosurgery, Rechts der Isar, Technische Universität München, GermanyObjective 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.http://www.e-neurospine.org/upload/pdf/ns-2040436-218.pdfbiomechanical studycervical spineconstruct testinginstrumentation patternsmultilevel constructsthree-column instability |
| spellingShingle | Sebastian Hartmann Claudius Thomé Anto Abramovic Sara Lener Werner Schmoelz Juliane Koller Heiko Koller 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 biomechanical study cervical spine construct testing instrumentation patterns multilevel constructs three-column instability |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | biomechanical study cervical spine construct testing instrumentation patterns multilevel constructs three-column instability |
| url | http://www.e-neurospine.org/upload/pdf/ns-2040436-218.pdf |
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