A biomechanical comparison of the Rogers interspinous and the Lovely—Carl tension band wiring techniques for fixation of the cervical spine

2000 ◽  
Vol 93 (1) ◽  
pp. 109-116
Author(s):  
Albert V. B. Brasil ◽  
Danilo G. Coelho ◽  
Tarcísio Eloy P. B. Filho ◽  
Fernando M. Braga
Keyword(s):  
Cervical Spine ◽  
Axial Rotation ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Lesion Group ◽  
Percentage Increase ◽  
Content Type ◽  
Flexion Extension ◽  
Biomechanical Evaluation ◽  
Fine Print

Object. The authors conducted a biomechanical study in which they compared the uses of the Rogers interspinous and the Lovely-Carl tension band wiring techniques for internal fixation of the cervical spine. Method. An extensive biomechanical evaluation (stiffness in positive and negative rotations around the x, y, and z axes; range of motion in flexion—extension, bilateral axial rotation, and bilateral bending; and neutral zone in flexion—extension, bilateral axial rotation, and lateral bending to the right and to the left) was performed in two groups of intact calf cervical spines. After these initial tests, all specimens were subjected to a distractive flexion Stage 3 ligamentous lesion. Group 1 specimens then underwent surgical fixation by the Rogers technique, and Group 2 specimens underwent surgery by using the Lovely—Carl technique. After fixation, specimens were again submitted to the same biomechanical evaluation. The percentage increase or decrease between the pre- and postoperative parameters was calculated. These values were considered quantitative indicators of the efficacy of the techniques, and the efficacy of the two techniques was compared. Conclusions. Analysis of the findings demonstrated that in the spines treated with the Lovely—Carl technique less restriction of movement was produced without affecting stiffness, compared with those treated with the Rogers technique, thus making the Lovely—Carl technique clinically less useful.

Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model

1996 ◽  
Vol 84 (6) ◽  
pp. 1039-1045 ◽  
Author(s):  
John D. Clausen ◽  
Timothy C. Ryken ◽  
Vincent C. Traynelis ◽  
Paul D. Sawin ◽  
Franklin Dexter ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Locking Plate ◽  
Axial Rotation ◽  
Biomechanical Stability ◽  
Content Type ◽  
Flexion Extension ◽  
Two Systems ◽  
Biomechanical Evaluation ◽  
The Moment ◽  
Cadaveric Model

✓ There exist two markedly different instrumentation systems for the anterior cervical spine: the Cervical Spine Locking Plate (CSLP) system, which uses unicortical screws with a locking hub mechanism for attachment, and the Caspar Trapezial Plate System, which is secured with unlocked bicortical screws. The biomechanical stability of these two systems was evaluated in a cadaveric model of complete C5–6 instability. The immediate stability was determined in six loading modalities: flexion, extension, right and left lateral bending, and right and left axial rotation. Biomechanical stability was reassessed following fatigue with 5000 cycles of flexion-extension, and finally, the spines were loaded in flexion until the instrumentation failed. The Caspar system stabilized significantly in flexion before (p < 0.05) but not after fatigue, and it stabilized significantly in extension before (p < 0.01) and after fatigue (p < 0.01). The CSLP system stabilized significantly in flexion before (p < 0.01) but not after fatigue, and it did not stabilize in extension before or after fatigue. The moment needed to produce failure in flexion did not differ substantially between the two plating systems. The discrepancy in the biomechanical stability of these two systems may be due to differences in bone screw fixation.

Posterior cervical spine fusion with tension-band wiring

1995 ◽  
Vol 83 (4) ◽  
pp. 631-635 ◽  
Author(s):  
Thomas J. Lovely ◽  
Allen Carl
Keyword(s):  
Cervical Spine ◽  
Early Mobilization ◽  
Fusion Rate ◽  
Spine Fusion ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Content Type ◽  
Subaxial Cervical Spine ◽  
Cervical Spine Fusion ◽  
Fine Print

✓ In this study the authors detail their experience with posterior tension-band wiring for stabilization of the subaxial cervical spine. Fifty-five patients underwent fusion for trauma (41 patients), degenerative disease (13 patients), and tumor (one patient). The fusion rate was 96% (50 of 52 patients) and postoperative immobilization was accomplished by means of a Philadelphia collar in the majority of cases. Tension-band wiring provides a stable construct that is simple to perform, requires fusion of a minium number of motion segments, and allows early mobilization with only a hard collar needed for support. The details of the technique, which has been modified from preliminary descriptions, are discussed.

Stabilizing effect of posterior lumbar interbody fusion cages before and after cyclic loading

2000 ◽  
Vol 92 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Annette Kettler ◽  
Hans-Joachim Wilke ◽  
Rupert Dietl ◽  
Matthias Krammer ◽  
Christianto Lumenta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Axial Rotation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Flexion Extension ◽  
Stabilizing Effect ◽  
Fine Print

Object. The function of interbody fusion cages is to stabilize spinal segments primarily by distracting them as well as by allowing bone ingrowth and fusion. An important condition for efficient formation of bone tissue is achieving adequate spinal stability. However, the initial stability may be reduced due to repeated movements of the spine during everyday activity. Therefore, in addition to immediate stability, stability after cyclic loading is of remarkable relevance; however, this has not yet been investigated. The object of this study was to investigate the immediate stabilizing effect of three different posterior lumbar interbody fusion cages and to clarify the effect of cyclic loading on the stabilization. Methods. Before and directly after implantation of a Zientek, Stryker, or Ray posterior lumbar interbody fusion cage, 24 lumbar spine segment specimens were each evaluated in a spine tester. Pure lateral bending, flexion—extension, and axial rotation moments (± 7.5 Nm) were applied continuously. The motion in each specimen was measured simultaneously. The specimens were then loaded cyclically (40,000 cycles, 5 Hz) with an axial compression force ranging from 200 to 1000 N. Finally, they were tested once again in the spine tester. Conclusions. In general, a decrease of movement in all loading directions was noted after insertion of the Zientek and Ray cages and an increase of movement after implantation of a Stryker cage. In all three cage groups greater stability was demonstrated in lateral bending and flexion than in extension and axial rotation. Reduced stability during cyclic loading was observed in all three cage groups; however, loss of stability was most pronounced when the Ray cage was used.

Cervical laminectomy without fusion in patients with rheumatoid arthritis

1999 ◽  
Vol 90 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Dan Christensson ◽  
Hans Säveland ◽  
Stefan Zygmunt ◽  
Kjell Jonsson ◽  
Urban Rydholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cord Compression ◽  
Spinal Instability ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Fusion Procedure ◽  
Cervical Laminectomy ◽  
Flexion Extension ◽  
Fine Print

Object. The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. Methods. Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion—extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6–24 months) and 43 months (28–72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. Conclusions. The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study

1999 ◽  
Vol 90 (1) ◽  
pp. 91-98 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
Robert F. Spetzler ◽  
Volker K. H. Sonntag ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Biomechanical Study ◽  
Occipital Condyle ◽  
Upper Cervical Spine ◽  
Lateral Bending ◽  
Content Type ◽  
Axial Translation ◽  
Flexion Extension ◽  
Fine Print

Object. The authors sought to determine the biomechanics of the occipitoatlantal (occiput [Oc]—C1) and atlantoaxial (C1–2) motion segments after unilateral gradient condylectomy. Methods. Six human cadaveric specimens (skull with attached upper cervical spine) underwent nondestructive biomechanical testing (physiological loads) during flexion—extension, lateral bending, and axial rotation. Axial translation from tension to compression was also studied across Oc—C2. Each specimen served as its own control and underwent baseline testing in the intact state. The specimens were then tested after progressive unilateral condylectomy (25% resection until completion), which was performed using frameless stereotactic guidance. At Oc—C1 for all motions that were tested, mobility increased significantly compared to baseline after a 50% condylectomy. Flexion—extension, lateral bending, and axial rotation increased 15.3%, 40.8%, and 28.1%, respectively. At C1–2, hypermobility during flexion—extension occurred after a 25% condylectomy, during axial rotation after 75% condylectomy, and during lateral bending after a 100% condylectomy. Conclusions. Resection of 50% or more of the occipital condyle produces statistically significant hypermobility at Oc—C1. After a 75% resection, the biomechanics of the Oc—C1 and C1–2 motion segments change considerably. Performing fusion of the craniovertebral junction should therefore be considered if half or more of one occipital condyle is resected.

Biomechanical analysis of a newly designed bioabsorbable anterior cervical plate

2005 ◽  
Vol 3 (6) ◽  
pp. 465-470 ◽  
Author(s):  
Christopher P. Ames ◽  
Frank L. Acosta ◽  
Robert H. Chamberlain ◽  
Adolfo Espinoza Larios ◽  
Neil R. Crawford
Keyword(s):  
Axial Rotation ◽  
Metal Plate ◽  
Biomechanical Analysis ◽  
Fibular Graft ◽  
Disc Disease ◽  
Content Type ◽  
Flexion Extension ◽  
Cervical Plate ◽  
Anterior Cervical Plate ◽  
Fine Print

Object. The authors present a biomechanical analysis of a newly designed bioabsorbable anterior cervical plate (ACP) for the treatment of one-level cervical degenerative disc disease. They studied anterior cervical discectomy and fusion (ACDF) in a human cadaveric model, comparing the stability of the cervical spine after placement of the bioabsorbable fusion plate, a bioabsorbable mesh, and a more traditional metallic ACP. Methods. Seven human cadaveric specimens underwent a C6–7 fibular graft—assisted ACDF placement. A one-level resorbable ACP was then placed and secured with bioabsorbable screws. Flexibility testing was performed on both intact and instrumented specimens using a servohydraulic system to create flexion—extension, lateral bending, and axial rotation motions. After data analysis, three parameters were calculated: angular range of motion, lax zone, and stiff zone. The results were compared with those obtained in a previous study of a resorbable fusion mesh and with those acquired using metallic fusion ACPs. For all parameters studied, the resorbable plate consistently conferred greater stability than the resorbable mesh. Moreover, it offered comparable stability with that of metallic fusion ACPs. Conclusions. Bioabsorbable plates provide better stability than resorbable mesh. Although the results of this study do not necessarily indicate that a resorbable plate confers equivalent stability to a metal plate, the resorbable ACP certainly yielded better results than the resorbable mesh. Bioabsorbable fusion ACPs should therefore be considered as alternatives to metal plates when a graft containment device is required.

Biomechanical studies of an artificial disc implant in the human cadaveric spine

2005 ◽  
Vol 2 (3) ◽  
pp. 339-343 ◽  
Author(s):  
Patrick W. Hitchon ◽  
Kurt Eichholz ◽  
Christopher Barry ◽  
Paige Rubenbauer ◽  
Aditya Ingalhalikar ◽  
...  
Keyword(s):  
Biomechanical Testing ◽  
Axial Rotation ◽  
Load Testing ◽  
Artificial Disc ◽  
Lateral Bending ◽  
Content Type ◽  
Intact State ◽  
Flexion Extension ◽  
Fine Print

Object. The authors compared the biomechanical performance of the human cadaveric spine implanted with a metallic ball-and-cup artificial disc at L4–5 with the spine's intact state and after anterior discectomy. Methods. Seven human L2—S1 cadaveric spines were mounted on a biomechanical testing frame. Pure moments of 0, 1.5, 3.0, 4.5, and 6.0 Nm were applied to the spine at L-2 in six degrees of motion (flexion, extension, right and left lateral bending, and right and left axial rotation). The spines were tested in the intact state as well as after anterior L4–5 discectomy. The Maverick disc was implanted in the discectomy defect, and load testing was repeated. The artificial disc created greater rigidity for the spine than was present after discectomy, and the spine performed biomechanically in a manner comparable with the intact state. Conclusions. The results indicate that in an in vitro setting, this model of artificial disc stabilizes the spine after discectomy, restoring motion comparable with that of the intact state.

Biomechanical testing of anterior and posterior thoracolumbar instrumentation in the cadaveric spine

2004 ◽  
Vol 1 (1) ◽  
pp. 116-121 ◽  
Author(s):  
Kurt M. Eichholz ◽  
Patrick W. Hitchon ◽  
Aaron From ◽  
Paige Rubenbauer ◽  
Satoshi Nakamura ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Degrees Of Freedom ◽  
Posterior Instrumentation ◽  
Axial Rotation ◽  
Anterior Instrumentation ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Intact State ◽  
Flexion Extension ◽  
Fine Print

Object. Thoracolumbar burst fractures frequently require surgical intervention. Although the use of either anterior or posterior instrumentation has advantages and disadvantages, there have been few studies in which these two approaches have been compared biomechanically. Methods. Ten human cadaveric spines were subjected to subtotal L-3 corpectomy. In five spines placement of L-3 wooden strut grafts with lateral L2–4 dual rod and screw instrumentation was performed. Five other spines underwent L1–5 pedicle screw fixation. The spines were fatigued between steps of the experiment. The spines were load tested with pure moments of 1.5, 3, 4.5, and 6 Nm in the intact state and after placement of instrumentation in six degrees of freedom (flexion, extension, right and left lateral bending, and right and left axial rotation). In axial rotation posterior instrumentation significantly increased spinal rigidity compared with that of the intact state, whereas anterior instrumentation did not. Combined anterior—posterior instrumentation did not significantly increase the rigidity of the spine when compared with anterior or posterior instrumentation alone. Posterior instrumentation alone provided a greater reduction in angular rotation compared with anterior instrumentation alone in all degrees of freedom; however, statistical significance was achieved only in extension at 6 Nm. Conclusions. The increased rigidity provided by pedicle screw instrumentation compared with the intact state or with anterior instrumentation is due to the longer construct spanning five levels and the three-column engagement of the pedicle screws. The decision to use anterior or posterior instrumentation should be based on the clinical necessity of canal decompression and correction of angulation.

Effect of a prosthetic disc nucleus on the mobility and disc height of the L4–5 intervertebral disc postnucleotomy

2001 ◽  
Vol 95 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Hans-Joachim Wilke ◽  
Sinead Kavanagh ◽  
Sylvia Neller ◽  
Christian Haid ◽  
Lutz Eberhart Claes
Keyword(s):  
Intervertebral Disc ◽  
Axial Rotation ◽  
Disc Height ◽  
In Vitro Test ◽  
Lateral Bending ◽  
Content Type ◽  
Intact State ◽  
Device Implantation ◽  
Flexion Extension ◽  
Fine Print

Object. Current procedures for treatment of degenerative disc disease may not restore flexibility or disc height to the intervertebral disc. Recently, a prosthetic device, intended to replace the degenerated nucleus pulposus, was developed. In this biomechanical in vitro test the authors study the effect of implanting a prosthetic nucleus in cadaveric lumbar intervertebral discs postnucleotomy and determine if the flexibility and disc height of the L4–5 motion segment is restored. Methods. The prosthetic disc nucleus device consists of two hydrogel pellets, each enclosed in a woven polyethylene jacket. Six human cadaveric lumbar motion segments (obtained in individuals who, at the time of death, were a mean age of 56.7 years) were loaded with moments of ± 7.5 Nm in flexion—extension, lateral bending, and axial rotation. The following states were investigated: intact, postnucleotomy, and after device implantation. Range of motion (ROM) and neutral zone (NZ) measurements were determined. Change in disc height from the intact state was measured after nucleotomy and device implantation, with and without a 200-N preload. Conclusions. Compared with the intact state (100%), the nucleotomy increased the ROM in flexion—extension to 118%, lateral bending to 112%, and axial rotation to 121%; once the device was implanted the ROM was reduced to 102%, 88%, and 90%, respectively. The NZ increased the ROM to 210%, lateral bending to 173%, and axial rotation to 107% after nucleotomy, and 146%, 149%, 44%, respectively, after device implantation. A 200-N preload reduced the intact and postnucleotomy disc heights by approximately 1 mm and 2 mm, respectively. The original intact disc height was restored after implantation of the device. The results of the cadaveric L4–5 flexibility testing indicate that the device can potentially restore ROM, NZ, and disc height to the denucleated segment.

Biomechanical comparison of anterior Caspar plate and three-level posterior fixation techniques in a human cadaveric model

1993 ◽  
Vol 79 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Vincent C. Traynelis ◽  
Paul A. Donaher ◽  
Robert M. Roach ◽  
H. Kojimoto ◽  
Vijay K. Goel
Keyword(s):  
Cervical Spine ◽  
Repeated Measures ◽  
Plate Fixation ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Lateral Bending ◽  
Anterior Plate ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Flexion Extension

✓ Traumatic cervical spine injuries have been successfully stabilized with plates applied to the anterior vertebral bodies. Previous biomechanical studies suggest, however, that these devices may not provide adequate stability if the posterior ligaments are disrupted. To study this problem, the authors simulated a C-5 teardrop fracture with posterior ligamentous instability in human cadaveric spines. This model was used to compare the immediate biomechanical stability of anterior cervical plating, from C-4 to C-6, to that provided by a posterior wiring construct over the same levels. Stability was tested in six modes of motion: flexion, extension, right and left lateral bending, and right and left axial rotation. The injured/plate-stabilized spines were more stable than the intact specimens in all modes of testing. The injured/posterior-wired specimens were more stable than the intact spines in axial rotation and flexion. They were not as stable as the intact specimens in the lateral bending or extension testing modes. The data were normalized with respect to the motion of the uninjured spine and compared using repeated measures of analysis of variance, the results of which indicate that anterior plating provides significantly more stability in extension and lateral bending than does posterior wiring. The plate was more stable than the posterior construct in flexion loading; however, the difference was not statistically significant. The two constructs provide similar stability in axial rotation. This study provides biomechanical support for the continued use of bicortical anterior plate fixation in the setting of traumatic cervical spine instability.

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