En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Disch, Alexander C.; Schaser, Klaus‐Dieter; Melcher, I.; Luzzati, Alessandro; Feraboli, Franco; Schmoelz, Werner

doi:10.1007/s00586-008-0588-y

Cited by 56 publications

(31 citation statements)

References 72 publications

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“…1) according to the recommendation for testing of spinal implants [19,33]. The setup of the spine tester was described in previous publications [5,16]. Flexibility tests were performed in the three main motion planes (lateral bending, flexion/extension and axial rotation) with pure bending moments of ±7.5 Nm.…”

Section: Methodsmentioning

confidence: 99%

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

et al. 2009

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In advanced stages of degenerative disease of the lumbar spine instrumented spondylodesis is still the golden standard treatment. However, in recent years dynamic stabilisation devices are being implanted to treat the segmental instability due to iatrogenic decompression or segmental degeneration. The purpose of the present study was to investigate the stabilising effect of a classical pedicle screw/rod combination, with a moveable hinge joint connection between the screw and rod allowing one degree of freedom (cosmicMIA). Six human lumbar spines (L2-5) were loaded in a spine tester with pure moments of ±7.5 Nm in lateral bending, flexion/extension and axial rotation. The range of motion (ROM) and the neutral zone were determined for the following states: (1) intact, (2) monosegmental dynamic instrumentation (L4-5), (3) bisegmental dynamic instrumentation (L3-5), (4) bisegmental decompression (L3-5), (5) bisegmental dynamic instrumentation (L3-5) and (6) bisegmental rigid instrumentation (L3-5). Compared to the intact, with monosegmental instrumentation (2) the ROM of the treated segment was reduced to 47, 40 and 77% in lateral bending, flexion/ extension and axial rotation, respectively. Bisegmental dynamic instrumentation (3) further reduced the ROM in L4-5 compared to monosegmental instrumentation to 25% (lateral bending), 28% (flexion/extension) and 57% (axial rotation). Bisegmental surgical decompression (4) caused an increase in ROM in both segments (L3-4 and L4-5) to approximately 125% and approximately 135% and 187-234% in lateral bending, flexion/extension and axial rotation, respectively. Compared to the intact state, bisegmental dynamic instrumentation after surgical decompression reduced the ROM of the two-bridged segments to 29-35% in lateral bending and 33-38% in flexion/extension. In axial rotation, the ROM was in the range of the intact specimen (87-117%). A rigid instrumentation (6) further reduced the ROM of the two-bridged segments to 20-30, 23-27 and 50-68% in lateral bending, flexion/ extension and axial rotation, respectively. The results of the present study showed that compared to the intact specimen the investigated hinged dynamic stabilisation device reduced the ROM after bisegmental decompression in lateral bending and flexion/extension. Following bisegmental decompression and the thereby caused large rotational instability the device is capable of restoring the motion in axial rotation back to values in the range of the intact motion segments.

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Section: Methodsmentioning

confidence: 99%

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

et al. 2009

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“…The number of segments removed influences spinal instability. Matsumoto identified spinal instrumentation failures in 40% of TES cases involving single-level resections 27) , and there have been some biomechanical reports of spinal reconstruction after single-level TES 25,26,[28][29][30][31][32][33] . However, only one study has evaluated the biomechanical effects of spinal reconstruction after multilevel TES 34) .…”

Section: Discussionmentioning

confidence: 99%

Risk factors of instrumentation failure after multilevel total en bloc spondylectomy

Yoshioka

Murakami

Demura

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Multilevel total en bloc spondylectomy (TES) is required to secure oncologically adequate resection margins. However, no useful information has been reported for spinal reconstruction after multilevel TES. Therefore, this study set out to assess the clinical and radiological outcomes of spinal reconstruction after multilevel TES. Methods: Forty-eight patients treated with multilevel TES at our institute were included in the analysis. Reconstruction was achieved with posterior pedicle screw fixation and an anterior titanium mesh cage filled with iliac autograft in all cases. Spinal shortening was performed to increase spinal stability from the reconstruction. Instrumentation failure and radiological findings were evaluated with radiography and computerized tomography (CT). Results: After excluding one patient whose general condition was deteriorating, radiological evaluations of 47 patients were performed over a period of more than a year. The follow-up time was 17 to 120 months (mean: 70.2 months). Instrumentation failure occurred in one patient (5.9%) after thoracic multilevel TES, in 4 patients (25.0%) after thoracolumbar multilevel TES, and in 3 patients (42.9%) after lumbar multilevel TES. No instrumentation failure was observed in cervicothoracic cases. Cage subsidence (>2 mm) occurred in 30 patients (63.8%). In 22 of them, subsidence appeared on the CT one month after surgery. The risk factors of instrumentation failure included a multilevel TES below the thoracolumbar level and a long span of vertebral resection. There was no instrumentation failure in any of the 11 "disc-to-disc cutting" cases. Conclusions: This study identified the risk factors of instrumentation failure after multilevel TES. There is a high risk of instrumentation failure in cases of long vertebral resection below the thoracolumbar level. On the other hand, our reconstruction method can be successful for multilevel TES above the thoracic level.

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“…Specimens were loaded with pure moments, applied by a stepper motor. A six-component load cell attached to the cranial end of the spine was used for feedback control of the stepper motor used to apply the bending moment [30][31][32][33]. All flexibility tests were carried out at room temperature.…”

Section: Flexibility Testsmentioning

confidence: 99%

Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing: biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw–plate fixation technique

Koller

Schmoelz

Zenner³

et al. 2015

Eur Spine J

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360°-instrumentation resembles the biomechanical standard of reference for stabilization of 2-level corpectomies. An ATS-construct was also shown to confer high construct stiffness, significantly reducing the percentage ROM beyond that of an intact specimen after 2,000 cycles. This type of instrumentation might be a clinical valuable and biomechanically sound adjunct to multilevel anterior surgical procedures.

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En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Cited by 56 publications

References 72 publications

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

Risk factors of instrumentation failure after multilevel total en bloc spondylectomy

Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing: biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw–plate fixation technique

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