Does addition of crosslink to pedicle-screw-based instrumentation impact the development of the spinal canal in children younger than 5 years of age?

Chen, Zhonghui; Chen, Xi; Zhu, Zezhang; Wang, Bin; Qian, Bangping; Zhu, Feng; Sun, Xu; Qiu, Yong

doi:10.1007/s00586-014-3727-7

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…After reviewing titles and abstracts, 12 studies remained for full-text assessment. Following inclusion and exclusion criteria, both reviewers identified seven publications that were systematically analyzed [28,[31][32][33][34][35][36].…”

Section: Resultsmentioning

confidence: 99%

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Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Heck

Oikonomidis

Prasse

et al. 2021

BioMed

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Cross-links increase the stability of screw-rod systems in biomechanical testing. The aim of this systemic review was to find evidence pertaining to the additional benefit of the implantation of cross-links in clinical practice in regard to different spinal diseases. Therefore, a systematic literature analysis of two online databases was performed according to the PRISMA statement. Inclusion criteria were prospective and retrospective studies investigating the use of cross-links in dorsal instrumentation. Biomechanical studies and case series were excluded. A total of seven retrospective studies remained for final full-text evaluation. In total, two studies each address the use of cross-links in adolescent idiopathic scoliosis, neuromuscular scoliosis or atlantoaxial fusion, one study in congenital scoliosis. In atlantoaxial fusion the additional use of cross-links may provide earlier bony fusion. In surgical treatment for pediatric scoliosis the additional use of cross-links does not provide additional benefit. Radiological outcome and complication rate did not differ in between groups. No study addressed the use of cross-links in short- or long-segment fusion due to degenerative or traumatic disorders of the spine. There is a deficiency in published literature towards the impact of cross-links in spinal surgery. The current clinical evidence data do not confirm the biomechanical advantages of cross-links in clinical practice. Further studies are needed to warrant the use of cross-links in the future.

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Section: Resultsmentioning

confidence: 99%

“…Chen et al retrospectively analyzed data of 34 patients with congenital scoliosis who underwent posterior hemi vertebrectomy and pedicle screw-based instrumentation in regard to the developmental state of the spinal canal [31]. A total of 20 girls and 14 boys were included.…”

Section: Scoliosismentioning

confidence: 99%

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Heck

Oikonomidis

Prasse

et al. 2021

BioMed

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“…Eliminating crosslinks reduces the operative time as well as the overall cost. Prominence of implants, corrosion, infection, implant failure, and pseudarthrosis are complications attributed to crosslinks in the literature, which can be avoided by preventing their incorporation into spinal constructs [35, 36].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis

Ouyang

Wang

Vaudreuil

et al. 2019

Journal of Healthcare Engineering

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Early-onset scoliosis (EOS) remains a challenging condition for which current nonfusion surgeries require iterative lengthening surgeries. A growing rod with sliding pedicle screw system (GRSPSS) was developed to treat spinal deformities without repeated operative lengthening. This study was performed to evaluate whether GRSPSS had similar stability as a conventional pedicle screw system to maintain deformity correction. A serial-linkage robotic manipulator with a six-axis load cell positioned on the end-effector was utilized to evaluate the mechanical stability of the GRSPSS versus conventional fixed scoliosis instrumentation. Ten skeletally mature thoracic female Katahdin sheep spines (T4-L1) were subjected to 2.5 Nm of flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in 2° increments for each state. The overall range of motion (ROM), apical segment ROM, and stiffness were calculated and reported. A two-tailed paired t-test was used to detect significant differences (p<0.05) between the fixed group and GRSPSS fixation. There were no significant differences in overall range of motion (ROM), apical segment ROM, or stiffness for FE or LB between the GRSPSS group and fixed group. In AR, the GRSPSS group showed increased ROM compared to the fixed group for the overall spine (36.0° versus 19.2°, p<0.01) and for the instrumented T8-T10 segments (7.0° versus 2.9°, p=0.02). Similarly, the fixed rod elastic zone (EZ) stiffness was significantly greater than the GRSPSS EZ stiffness (0.29 N/m versus 0.17 N/m, p<0.001). The space around the rod allows for the increased AR observed with the GRSPSS fusion technique and is necessary for axial growth. The GRSPSS fusion model shows equivalent flexion and LB stability to current fusion models and represents a stable fusion technique and may allow for longitudinal growth during childhood.

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“…Even though the result of facetectomy is superior in axial rotation than in the bending planes, all variances are in a few tenths of a degree below this loading model. Cross-links cannot be therefore clinically supported based on these minor biomechanical alterations (Figure 2) [49][50][51][52].…”

Section: Interbody Fusion and Cross-linksmentioning

confidence: 99%

“…Moreover, addition cross-links to screws and rods did not negatively affect the growth of the spinal canal. It is therefore recommended that cross-links be added to instrumentation to increase the fixation stability, especially in growing patients [52].…”

Section: Complicationsmentioning

confidence: 99%

Skipping Cross Links in Posterior Spine Surgery: A Review

Shafizad

Haddadi

2020

Iran J Neurosurg

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Background and Aim: Given the conflicting and unreliable evidence for using cross-links in posterior spine surgery, this review was conducted to highlight the different features and usefulness of these augmentation devices in spine surgeries. Methods and Materials/Patients: After searching databases using specific keywords, the relevant articles were ultimately selected and evaluated. Results: Biomechanically investigating the use of cross-links has not resulted in unanimous explanations for their effect. The site and direction of cross-links have been rarely investigated in the literature. Some studies recommended eliminating their application from clinical practice; nevertheless, these studies do not necessarily yield clinical benefits. Posterior spinal fixation with pedicle screws and without cross-links offers stability in all the planes in most clinical conditions. Conclusion: Excluding the cross-links in posterior spine surgery may shorten the operation time and reduce hospital costs. Researchers have reported other problems for cross-links such as late pain, device failure, infections, device prominence, and pseudarthrosis which may be obliterated through the avoidance of their combination in a spinal construct; nevertheless, the results of animal models of the application of special cross-links in a degenerative disorder or deformity suggest that diagonal cross-links provide the highest stability of the construct if they are matched with a rodonly system or with transverse cross-link constructs resulting in a rectangular configuration.

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Does addition of crosslink to pedicle-screw-based instrumentation impact the development of the spinal canal in children younger than 5 years of age?

Cited by 12 publications

References 35 publications

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis

Skipping Cross Links in Posterior Spine Surgery: A Review

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