Is pelvic fixation the only option to provide additional stability to the sacral anchorage in long lumbar instrumentation? A comparative biomechanical study of new techniques

被引：9
作者：
Volkheimer, David [1 ]
Reichel, Heiko [2 ]
Wilke, Hans-Joachim [1 ]
Lattig, Friederike [2 ,3 ]
机构：
[1] Ulm Univ, Med Ctr, Trauma Res Ctr Ulm ZIF, Inst Orthoped Res & Biomech, Ulm, Germany
[2] Orthoped Univ Hosp RKU, Ulm, Germany
[3] Berit Paracelsus Clin, Speicher, Switzerland
来源：
CLINICAL BIOMECHANICS | 2017年 / 43卷
关键词：
Lumbosacral instrumentation; Fixation techniques; Biomechanics; Lumbar fusion; In vitro; TRANSLAMINAR FACET SCREW; SPINAL DEFORMITY; PEDICLE SCREW; POSTERIOR INSTRUMENTATION; SACROPELVIC FIXATION; LUMBOSACRAL FIXATION; INTERBODY FUSION; LAMINAR HOOKS; ADULT; SCOLIOSIS;
D O I：
10.1016/j.clinbiomech.2017.02.001
中图分类号：
R318 [生物医学工程];
学科分类号：
0831 ;
摘要：
Background: Supplementary iliac screws have the highest potential to protect S1-pedicle-screws from loosening in long fusion constructs. However, this technique bridges the iliosacral joint with potential disadvantages for the patient. This study aimed to evaluate if two different established fixation techniques can be used in addition to pedicle screws as alternative to iliac screws, and if these two techniques can provide similar stability when S1-edicle-screws are loosened. Methods: Flexibility testing with pure moments of 7.5 Nm was performed with six human osteopenic/osteoporotic L4-pelvis specimens. The following conditions were investigated: 1. Intact; 2. Destabilization L5/S1; 3. Fixation with rigid L4-S1 pedicle-screw-system; 4. Condition 3- loosening of S1-screws; 5. Condition 4- L5-S2-lamina-hooks; 6. Condition 4- L5/S1-translaminar-screws; 7. Condition 4- S2-ala-ilium screws. Findings: Application of compressive L5-S2-lamina-hooks or L5/S1-translaminar-screws next to pedicle screws in L5 and S1 was feasible in all specimens. L4-S1-pedicle-screw-instrumentation reduced the Range of Motion significantly compared to the destabilized condition. After simulation of S1 screw loosening, lamina hooks only reduced the Range of Motion in flexion/extension significantly. L5/S1-translaminar-screws had a higher stabilizing effect in lateral bending and axial rotation, but the effect of both systems was smaller than with an instrumentation extension to the os ilium. Interpretation: In long lumbar pedicle screw instrumentations including L5/S1, additional ilium screws have the highest potential to protect the Si-anchorage. Additional L5/S1-translaminar-screws can increase stability of the lumbosacral junction without bridging the iliosacral joint, whereas lamina hooks showed no significant biomechanical benefit (C) 2017 Elsevier Ltd. All rights reserved.
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页码：34 / 39
页数：6
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