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Biomechanical Effects of a Dynamic Topping off Instrumentation in a Long Rigid Pedicle Screw Construct.
Reichl, Michael; Kueny, Rebecca A; Danyali, Reza; Obid, Peter; Übeyli, Hüseyin; Püschel, Klaus; Morlock, Michael M; Huber, Gerd; Niemeyer, Thomas; Richter, Alexander.
Afiliación
  • Reichl M; *Spine Center, Asklepios Klinik St. Georg †Institute of Biomechanics, TUHH Hamburg University of Technology ‡Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Clin Spine Surg ; 30(4): E440-E447, 2017 05.
Article en En | MEDLINE | ID: mdl-28437350
STUDY DESIGN: Biomechanical ex vivo study. OBJECTIVE: To determine if topping off instrumentation can reduce the hypermobility in the adjacent segments when compared with the classic rigid spinal instrumentation. SUMMARY OF THE BACKGROUND DATA: Long rigid instrumentation might increase the mechanical load in the adjacent segments, the resulting hypermobility, and the risk for adjacent segment disease. Topping off instrumentation intends to reduce the hypermobility at the adjacent level by more evenly distributing segmental motion and, thereby, potentially mitigating adjacent level disease. MATERIALS AND METHODS: Eight human spines (Th12-L5) were divided into 2 groups. In the rigid group, a 3-segment metal rod instrumentation (L2-L5) was performed. The hybrid group included a 2-segment metal rod instrumentation (L3-L5) with a dynamic topping off instrumentation (L2-L3). Each specimen was tested consecutively in 3 different configurations: native (N=8), 2-segment rod instrumentation (L3-L5, N=8), 3-segment instrumentation (rigid: N=4, hybrid: N=4). For each configuration the range of motion (ROM) of the whole spine and each level was measured by a motion capture system during 5 cycles of extension-flexion (angle controlled to ±5 degrees, 0.1 Hz frequency, no preload). RESULTS: In comparison with the intact spine, both the rigid 3-segment instrumentation and the hybrid instrumentation significantly reduced the ROM in the instrumented segments (L2-L5) while increasing the movement in the adjacent segment L1-L2 (P=0.002, η=0.82) and in Th12-L1 (P<0.001, η=0.90). There were no ROM differences between the rigid and hybrid instrumentation in all segments. CONCLUSIONS: Introducing the dynamic topping off did not impart any significant difference in the segmental motion when compared with the rigid instrumentation. Therefore, the current biomechanical study could not show a benefit of using this specific topping off instrumentation to solve the problem of adjacent segment disease.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Ortopédicos / Tornillos Pediculares Tipo de estudio: Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Spine Surg Año: 2017 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Ortopédicos / Tornillos Pediculares Tipo de estudio: Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Spine Surg Año: 2017 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos