Posterior spinal instrumentation and decompression with or without cross-link?

Background: Posterior lumbar instrumentation requires sufficient primary stiffness to ensure bony fusion and to avoid pseudarthrosis, screw loosening, or implant failure. To enhance primary construct stiffness, transverse cross-link (CL) connectors attached to the vertical rods can be used. Their ef...

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Autores principales:	Marco D. Burkhard, Frédéric Cornaz, José Miguel Spirig, Florian Wanivenhaus, Rafael Loucas, Marie-Rosa Fasser, Jonas Widmer, Mazda Farshad
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cross-link Cross-connector Spine lumbar Instrumentation Segmental stability Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/96df83aed19f4fd9925d2d6fde02b370
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spelling	oai:doaj.org-article:96df83aed19f4fd9925d2d6fde02b3702021-12-02T05:03:55ZPosterior spinal instrumentation and decompression with or without cross-link?2666-548410.1016/j.xnsj.2021.100093https://doaj.org/article/96df83aed19f4fd9925d2d6fde02b3702021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666548421000457https://doaj.org/toc/2666-5484Background: Posterior lumbar instrumentation requires sufficient primary stiffness to ensure bony fusion and to avoid pseudarthrosis, screw loosening, or implant failure. To enhance primary construct stiffness, transverse cross-link (CL) connectors attached to the vertical rods can be used. Their effect on the stability of a spinal instrumentation with simultaneous decompression is yet not clear. This study aimed to evaluate the impact of CL augmentation on single-level lumbar instrumentation stiffness after gradual decompression procedures. Methods: Seventeen vertebral segments (6 L1/2, 6 L3/4, 5 L5/S1) of 12 fresh-frozen human cadavers were instrumented with a transpedicular screw–rod construct following the traditional pedicle screw trajectory. Range of motion (ROM) of the segments was sequentially recorded before and after four procedures: (A) instrumented before decompression, (B) instrumented after unilateral laminotomy, (C) instrumented after midline bilateral laminotomy, and (D) instrumented after unilateral facetectomy (with transforaminal lumbar interbody fusion [TLIF]). Each test was performed with and without CL augmentation. The motion between the cranial and caudal vertebrae was evaluated in all six major loading directions: flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression/distraction (AC). Results: ROM was significantly reduced with CL augmentation in AR by Δ0.03–0.18° (7–12%) with a significantly higher ROM reduction after more extensive decompression. Furthermore, slight reductions in FE and LB were observed; these reached statistical significance for FE after facetectomy and TLIF insertion only (Δ0.15; 3%). The instrumentation levels did not reveal any subgroup differences. Conclusion: CL augmentation reduces AR-ROM by 7–12% in single-level instrumentation of the lumbar spine, with the effect increasing along with the extensiveness of the decompression technique. In light of the discrete absolute changes, CL augmentation may be warranted for highly unstable vertebral segments rather than for standard single-level posterior spinal fusion and decompression.Marco D. BurkhardFrédéric CornazJosé Miguel SpirigFlorian WanivenhausRafael LoucasMarie-Rosa FasserJonas WidmerMazda FarshadElsevierarticleCross-linkCross-connectorSpinelumbarInstrumentationSegmental stabilityOrthopedic surgeryRD701-811Neurology. Diseases of the nervous systemRC346-429ENNorth American Spine Society Journal, Vol 8, Iss , Pp 100093- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cross-link Cross-connector Spine lumbar Instrumentation Segmental stability Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Cross-link Cross-connector Spine lumbar Instrumentation Segmental stability Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429 Marco D. Burkhard Frédéric Cornaz José Miguel Spirig Florian Wanivenhaus Rafael Loucas Marie-Rosa Fasser Jonas Widmer Mazda Farshad Posterior spinal instrumentation and decompression with or without cross-link?
description	Background: Posterior lumbar instrumentation requires sufficient primary stiffness to ensure bony fusion and to avoid pseudarthrosis, screw loosening, or implant failure. To enhance primary construct stiffness, transverse cross-link (CL) connectors attached to the vertical rods can be used. Their effect on the stability of a spinal instrumentation with simultaneous decompression is yet not clear. This study aimed to evaluate the impact of CL augmentation on single-level lumbar instrumentation stiffness after gradual decompression procedures. Methods: Seventeen vertebral segments (6 L1/2, 6 L3/4, 5 L5/S1) of 12 fresh-frozen human cadavers were instrumented with a transpedicular screw–rod construct following the traditional pedicle screw trajectory. Range of motion (ROM) of the segments was sequentially recorded before and after four procedures: (A) instrumented before decompression, (B) instrumented after unilateral laminotomy, (C) instrumented after midline bilateral laminotomy, and (D) instrumented after unilateral facetectomy (with transforaminal lumbar interbody fusion [TLIF]). Each test was performed with and without CL augmentation. The motion between the cranial and caudal vertebrae was evaluated in all six major loading directions: flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression/distraction (AC). Results: ROM was significantly reduced with CL augmentation in AR by Δ0.03–0.18° (7–12%) with a significantly higher ROM reduction after more extensive decompression. Furthermore, slight reductions in FE and LB were observed; these reached statistical significance for FE after facetectomy and TLIF insertion only (Δ0.15; 3%). The instrumentation levels did not reveal any subgroup differences. Conclusion: CL augmentation reduces AR-ROM by 7–12% in single-level instrumentation of the lumbar spine, with the effect increasing along with the extensiveness of the decompression technique. In light of the discrete absolute changes, CL augmentation may be warranted for highly unstable vertebral segments rather than for standard single-level posterior spinal fusion and decompression.
format	article
author	Marco D. Burkhard Frédéric Cornaz José Miguel Spirig Florian Wanivenhaus Rafael Loucas Marie-Rosa Fasser Jonas Widmer Mazda Farshad
author_facet	Marco D. Burkhard Frédéric Cornaz José Miguel Spirig Florian Wanivenhaus Rafael Loucas Marie-Rosa Fasser Jonas Widmer Mazda Farshad
author_sort	Marco D. Burkhard
title	Posterior spinal instrumentation and decompression with or without cross-link?
title_short	Posterior spinal instrumentation and decompression with or without cross-link?
title_full	Posterior spinal instrumentation and decompression with or without cross-link?
title_fullStr	Posterior spinal instrumentation and decompression with or without cross-link?
title_full_unstemmed	Posterior spinal instrumentation and decompression with or without cross-link?
title_sort	posterior spinal instrumentation and decompression with or without cross-link?
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/96df83aed19f4fd9925d2d6fde02b370
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Posterior spinal instrumentation and decompression with or without cross-link?

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