Biomechanical Effects of a Dynamic Topping off Instrumentation in a Long Rigid Pedicle Screw Construct.
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Procedimientos Ortopédicos
/
Tornillos Pediculares
Tipo de estudio:
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Clin Spine Surg
Año:
2017
Tipo del documento:
Article
País de afiliación:
Alemania
Pais de publicación:
Estados Unidos