Pereira Bernardo de Andrada, Godzik Jakub, Lehrman Jennifer N, Sawa Anna G U, Hlubek Randall J, Uribe Juan S, Kelly Brian P, Turner Jay D
Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Spine (Phila Pa 1976). 2022 Apr 15;47(8):640-647. doi: 10.1097/BRS.0000000000004328. Epub 2022 Jan 31.
Fourteen cadaveric specimens were separated into two groups: (1) L3 pedicle subtraction osteotomy (PSO) with transforaminal lumbar interbody fusion (TLIF) or (2) lateral lumbar interbody fusion (LLIF). A 2-rod configuration (2R) was compared with two supplemental rod configurations: 4-rod (4R) with accessory rods (ARs) using connectors or 4R with satellite rods (SRs) without connectors.
Compare PSO constructs with different rod configurations and adjacent-level interbody support.
Supplemental rods and anterior column support enhance biomechanical performance.
Pure moments were applied in (1) intact, (2) pedicle screws and rods, (3) PSO + 2R, (4) 4R AR, and (5) 4R SR conditions. Primary and supplemental rods had strain gauges across the index level. Sacral screw bending moments and range of motion (ROM) were recorded.
For TLIF, AR decreased ROM during flexion (P = 0.02) and extension (P < 0.001) versus 2R. For LLIF, AR and SR decreased motion versus 2R during left (AR: P = 0.03; SR: P = 0.04) and right (AR: P = 0.002; SR: P = 0.01) axial rotation. For LLIF, sacral screw strain increased with SR compared with AR in compression and right lateral bending (P ≤ 0.03). During lateral bending, rod strain increased with PSO+TLIF+SR versus PSO+LLIF+2R and PSO+LLIF+AR (P ≤ 0.02). For LLIF, SR configuration increased rod strain versus AR during flexion, extension, and lateral bending (P≤ 0.01); for TLIF, rod strain increased with SR versus AR during extension (P = 0.03). For LLIF, AR configuration increased posterior supplemental rod strain versus SR during flexion (P = 0.02) and lateral bending (P < 0.001).
Both supplemental rod configurations reduced motion in both groups. Constructs with the SR configuration increased the primary rod strain and the sacral screw bending moment compared with AR constructs, which can share strain. Deep-seated SRs, which have become increasingly popular, may be more vulnerable to failure than ARs. LLIF provided more stability in sagittal plane. Protective effect of supplemental rods on rod strain was more effective with TLIF.Level of Evidence: NA.
14个尸体标本被分为两组：（1）经椎间孔腰椎椎体间融合术（TLIF）联合L3椎弓根截骨术（PSO），或（2）腰椎外侧椎体间融合术（LLIF）。将双棒配置（2R）与两种补充棒配置进行比较：使用连接器的带辅助棒（AR）的四棒（4R）配置或不带连接器的带卫星棒（SR）的4R配置。
比较不同棒配置和相邻节段椎体间支撑的PSO结构。
补充棒和前柱支撑可增强生物力学性能。
在以下五种情况下施加纯力矩：（1）完整状态，（2）椎弓根螺钉和棒，（3）PSO + 2R，（4）4R AR，以及（5）4R SR。主棒和补充棒在索引节段均设有应变片。记录骶骨螺钉的弯矩和活动范围（ROM）。
对于TLIF，与2R相比，AR在屈曲（P = 0.02）和伸展（P < 0.001）时可降低ROM。对于LLIF，与2R相比，AR和SR在左侧（AR：P = 0.03；SR：P = 0.04）和右侧（AR：P = 0.002；SR：P = 0.01）轴向旋转时可减少活动。对于LLIF，在压缩和右侧侧弯时，与AR相比，SR会使骶骨螺钉应变增加（P≤0.03）。在侧弯过程中，与PSO + LLIF + 2R和PSO + LLIF + AR相比，PSO + TLIF + SR会使棒应变增加（P≤0.02）。对于LLIF，在屈曲、伸展和侧弯时，SR配置的棒应变比AR增加（P≤0.01）；对于TLIF，在伸展时，SR配置的棒应变比AR增加（P = 0. .03）。对于LLIF，在屈曲（P = 0.02）和侧弯（P < 0.001）时，AR配置的后补充棒应变比SR增加。
两种补充棒配置均可减少两组的活动。与可分担应变的AR结构相比，SR配置的结构会增加主棒应变和骶骨螺钉弯矩。越来越受欢迎的深部SR可能比AR更容易发生失效。LLIF在矢状面提供了更高的稳定性。补充棒对棒应变的保护作用在TLIF中更有效。证据等级：无。
