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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 2020년 17권 3호 p.610 ~ 629
Hartmann Sebastian, Thome Claudius, Abramovic Anto, Lener Sara, Schmoelz Werner, Koller Juliane, Koller Heiko,
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 ( Hartmann Sebastian ) - Medical University of Innsbruck Department of Neurosurgery
 ( Thome Claudius ) - Medical University of Innsbruck Department of Neurosurgery
 ( Abramovic Anto ) - Medical University of Innsbruck Department of Neurosurgery
 ( Lener Sara ) - Medical University of Innsbruck Department of Neurosurgery
 ( Schmoelz Werner ) - Medical University of Innsbruck Department of Trauma Surgery
 ( Koller Juliane ) - Schoen Clinic Vogtareuth Department of Orthopedic Surgery
 ( Koller Heiko ) - Technische Universitat Munchen Department of Neurosurgery

Abstract


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.

키워드

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

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