Internal Fixation in Lumbosacral Spine Fusion A Biomechanical and Clinical Study

Kornblatt, Michael D.; Casey, Michael P.; Jacobs, Rae R.

doi:10.1097/00003086-198602000-00017

Cited by 111 publications

(57 citation statements)

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“…Translaminar screws in the lumbar spine demonstrate similar stiffness to pedicle screws, except in extension [13]. A compression-resistant graft inserted between the spinous processes is able to counteract this disadvantage.…”

Section: Discussionmentioning

confidence: 99%

Titanium mesh cages (TMC) in spine surgery

2004

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Section: Discussionmentioning

confidence: 99%

Titanium mesh cages (TMC) in spine surgery

2004

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“…In spite of the relatively small volume of the screws and the technical simplicity of correct screw insertion, the mechanical stiffness of the instrumented spine is 2.4 times that of the uninstrumented spine. In static loading tests [17,25] and in cyclic loading tests stiffness was maintained for 5000 cycles [17] with this technique.…”

Section: Discussionmentioning

confidence: 99%

“…As the load passes partially through the facets, the lever arm acting on an immobilizing internal fixation device within the area of the facets remains short. A low-profile fixation is sufficient to block the segment efficiently to enhance solid bony fusion [17,25].…”

Section: Introductionmentioning

confidence: 99%

Translaminar screw fixation in the lumbar spine: technique, indications, results

Grob¹,

Humke²

1998

E Spine J

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IntroductionFixation of the lumbar and lumbosacral spine with pedicle screws is presently the most common technique for internal fixation in the lumbar spine, and has been widely used for a variety of indications for almost 30 years [26,27,35]. However, the use of posterior internal fixation to increase fusion rates was first attempted, to our knowledge, as early as 1891, when a wiring technique for spinal fusion was introduced by Hadra [14]. Reports of various techniques with different implants were published in the following years. The use of facet screws was first reported by King in 1948 [24], whose technique was to immobilize the lumbosacral joints with a short screw, transversing the facet. With his technique, he achieved a fusion rate of 91% without prolonged rigid external fixation postoperatively. Boucher [4a] reported a slightly different technique of screw insertion. He tried to improve the bony purchase by penetrating the ipsilateral pedicle with the tip of the screw. Using this technique, he considerably improved the fusion rate, which he reported as 100% in single-level fusions. However, the tip of the screw had to be placed near the foramen and the nerve root, which carries potential risk of injury.Another modification of the technique of transfixing facets with screws was introduced by Magerl in 1984 [27]. Magerl's idea of inserting the screw from the contralateral side, through the lamina, eliminated the disadvantages of the former techniques without losing their advantages. Bony purchase was increased by the passage of the screw through the lamina, and the procedure is less risky, as (1) the insertion of the screw is clearly posterior to the neural elements and can be performed under direct visual control, and (2) the direction of the screw is parallel to the exiting nerve root.The present review is based on a vast experience covering 15 years of clinical application of translaminar screws. It focuses on the indications, advantages, and contra-indications of this technique.Abstract Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after discectomies, and painful discrelated syndromes such as internal disc disruption and lumbar disc herniation with concomitant degenerative changes. As an additional stabilization procedure, translaminar screws can be used to augment anterior fusion or reinforce pedicle systems. Translaminar screw fixation achieves as high fusion rate provided the biomechanical principles of the lumbar spine with an intact anterior column are respected and a meticulous operative technique is employed to enhance bony ingrowth of the graft.

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“…Biomechanical findings support the relevance of this classification in two ways. There is an increase of biomechanical strength of fixation from zone 1 to zone 3, and each mode of fixation in each zone has been associated with unique modes of failure [46][47][48][49][50][51]. Biomechanically, sacral screws alone represent the weakest form of sacropelvic anchorage in long spine fusion to the sacrum with an associated high rate of failure of fixation [52].…”

Section: Operative Techniquesmentioning

confidence: 99%

“…Its corrective power regarding pelvic obliquity correction in neuromuscular patients ranges from 40 % to 77 % in retrospectives series at final follow-up [19,[55][56][57][58][59]. But as the rod is smooth and crosses the unfused sacroiliac joint, its mechanical mode of failure is proximal displacement between the iliac tables, leading to the "windshield wiper" effect over time [46]. This radiological finding is not always associated with a defect of fusion.…”

Section: Galveston Techniquementioning

confidence: 99%

Pelvic fixation for neuromuscular scoliosis deformity correction

Dayer¹,

Ouellet

Saran

2012

Curr Rev Musculoskelet Med

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Pelvic fixation is most frequently indicated in the pediatric population for the treatment of neuromuscular scoliosis with significant pelvic obliquity. Neuromuscular scoliosis surgery is associated with a high risk of complications, and this is further increased by extension of fusion to the sacrum. Numerous techniques have been described for pelvic fixation associated with a long spine fusion each with its own set of specific benefits and risks. This article reviews the contemporary surgical techniques of pelvic fixation used to extend a spine fusion to the sacrum and pelvis focusing on the management of neuromuscular scoliosis, including their biomechanical rationale, results, and complications.

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Internal Fixation in Lumbosacral Spine Fusion A Biomechanical and Clinical Study

Cited by 111 publications

References 1 publication

Titanium mesh cages (TMC) in spine surgery

Titanium mesh cages (TMC) in spine surgery

Translaminar screw fixation in the lumbar spine: technique, indications, results

Pelvic fixation for neuromuscular scoliosis deformity correction

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