Topping-Off a Long Thoracic Stabilization With Semi-Rigid Constructs May Have Favorable Biomechanical Effects to Prevent Proximal Junctional Kyphosis: A Biomechanical Comparison.

Autor:	Cadieux C; London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada., Brzozowski P; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada., Fernandes RJR; London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada., McGregor ME; Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada., Zdero R; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada., Bailey CS; London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada.; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada., McLachlin SD; Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada., Rasoulinejad P; London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, London, ON, Canada.; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2024 Jun 03, pp. 21925682241259695. Date of Electronic Publication: 2024 Jun 03.
DOI:	10.1177/21925682241259695
Abstrakt:	Study Design: In-vitro cadaveric biomechanical study. Objectives: Long posterior spinal fusion is a standard treatment for adult spinal deformity. However, these rigid constructs are known to alter motion and stress to the adjacent non-instrumented vertebrae, increasing the risk of proximal junctional kyphosis (PJK). This study aimed to biomechanically compare a standard rigid construct vs constructs "topped off" with a semi-rigid construct. By understanding semi-rigid constructs' effect on motion and overall construct stiffness, surgeons and researchers could better optimize fusion constructs to potentially decrease the risk of PJK and the need for revision surgery. Methods: Nine human cadaveric spines (T1-T12) underwent non-destructive biomechanical range of motion tests in pure bending or torsion and were instrumented with an all-pedicle-screw (APS) construct from T6-T9. The specimens were sequentially instrumented with semi-rigid constructs at T5: (i) APS plus sublaminar bands; (ii) APS plus supralaminar hooks; (iii) APS plus transverse process hooks; and (iv) APS plus short pedicle screws. Results: APS plus transverse process hooks had a range of motion (ie, relative angle) for T4-T5 and T5-T6, as well as an overall mechanical stiffness for T1-T12, that was more favourable, as it reduced motion at adjacent levels without a stark increase in stiffness. Moreover, APS plus transverse process hooks had the most linear change for range of motion across the entire T3-T7 range. Conclusions: Present findings suggest that APS plus transverse process hooks has a favourable biomechanical effect that may reduce PJK for long spinal fusions compared to the other constructs examined. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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