Does index-level pedicle screw instrumentation affect cage subsidence after vertebral body replacement? - A biomechanical study in human cadaveric osteoporotic specimens.
Biomechanics
Complications
Index level
Obelisc
Pedicle screw
Spine surgery
Vertebral body replacement
Journal
Clinical biomechanics (Bristol, Avon)
ISSN: 1879-1271
Titre abrégé: Clin Biomech (Bristol, Avon)
Pays: England
ID NLM: 8611877
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
03
06
2023
revised:
18
08
2023
accepted:
18
08
2023
pubmed:
1
9
2023
medline:
1
9
2023
entrez:
31
8
2023
Statut:
ppublish
Résumé
Vertebral body replacement is a common surgical procedure for treatment of disorders associated with spinal instability. Therefore, pedicle screws are usually inserted in adjacent vertebrae for stabilization of the posterior column, however, there is lack of evidence whether implantation of index-level pedicle screws is beneficial or not. This biomechanical study aims to investigate the effect of pedicle screw instrumentation on axial stability following vertebral body replacement. Unstable fracture at L3 level was simulated in lumbar spines from six human cadaveric specimens. Then instrumentation was performed one level above / one level below index level in three specimens and further, three specimens were instrumented at index-level (L3) additionaly. Then we used a testing protocol for biomechanical evaluation of axial loading on human cadaveric lumbar spines until cage subsidence occurred. Our results show that index-level instrumented spines endured significantly higher load until cage subsidence occurred compared to non-index-level instrumented specimens (p = 0.05). Our results demonstrate pedicle screw instrumentation at index-level vertebra should be considered when possbile as it may have a protective effect against cage subsidence in patients undergoing vertebral body replacement surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Vertebral body replacement is a common surgical procedure for treatment of disorders associated with spinal instability. Therefore, pedicle screws are usually inserted in adjacent vertebrae for stabilization of the posterior column, however, there is lack of evidence whether implantation of index-level pedicle screws is beneficial or not. This biomechanical study aims to investigate the effect of pedicle screw instrumentation on axial stability following vertebral body replacement.
METHODS
METHODS
Unstable fracture at L3 level was simulated in lumbar spines from six human cadaveric specimens. Then instrumentation was performed one level above / one level below index level in three specimens and further, three specimens were instrumented at index-level (L3) additionaly. Then we used a testing protocol for biomechanical evaluation of axial loading on human cadaveric lumbar spines until cage subsidence occurred.
FINDINGS
RESULTS
Our results show that index-level instrumented spines endured significantly higher load until cage subsidence occurred compared to non-index-level instrumented specimens (p = 0.05).
INTERPRETATION
CONCLUSIONS
Our results demonstrate pedicle screw instrumentation at index-level vertebra should be considered when possbile as it may have a protective effect against cage subsidence in patients undergoing vertebral body replacement surgery.
Identifiants
pubmed: 37651900
pii: S0268-0033(23)00206-1
doi: 10.1016/j.clinbiomech.2023.106075
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106075Informations de copyright
Copyright © 2023 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial intererests or personal relationships that could have appeared to influence the work reported in this paper.