Abstract
BackgroundShort-segment pedicle screw instrumentation (SSPI) is used for unstable burst fractures to correct deformity and stabilize the spine for fusion. However, pedicle screw loosening, pullout, or breakage often occurs due to the large moment applied during spine motion, leading to poor outcomes. The purpose of this study was to test the ability of a newly designed device, the Trans-Endplate Pedicle Pillar System (TEPPS), to enhance SSPI rigidity and decrease the screw bending moment with a simple posterior approach.MethodsSix human cadaveric spines (T11-L3) were harvested. A burst fracture was created at L1, and the SSPI (Moss Miami System) was used for SSPI fixation. Strain gauge sensors were mounted on upper pedicle screws to measure screw load bearing. Segmental motion (T12-L2) was measured under pure moment of 7.5 Nm. The spine was tested sequentially under 4 conditions: intact; first SSPI alone (SSPI-1); SSPI+TEPPS; and second SSPI alone (SSPI-2).ResultsSSPI+TEPPS increased fixation rigidity by 41% in flexion/extension, 28% in lateral bending, and 37% in axial rotation compared with SSPI-1 (P<0.001), and it performed even better compared to SSPI-2 (P<0.001 for all). Importantly, the bending moment on the pedicle screws for SSPI+TEPPS was significantly decreased 63% during spine flexion and 47% in lateral bending (p<0.001).ConclusionTEPPS provided strong anterior support, enhanced SSPI fixation rigidity, and dramatically decreased the load on the pedicle screws. Its biomechanical benefits could potentially improve fusion rates and decrease SSPI instrumentation failure.
Highlights
Burst fracture in spine is an unstable fracture that often needs surgical stabilization with instrumentational fixation.[1,2,3] Numerous spinal internal fixation implants are available to stabilize the fracture segment using an anterior or a posterior approach.[4,5,6] The goal of any implant is to create and maintain reduction until spinal fusion occurs
Short-segment pedicle instrumentation (SSPI)+Trans-Endplate Pedicle Pillar System (TEPPS) increased fixation rigidity by 41% in flexion/extension, 28% in lateral bending, and 37% in axial rotation compared with SSPI-1 (P
Short-segment pedicle instrumentation (SSPI) is commonly used for unstable burst fractures. [2, 7, 8]SSPI has enabled surgeons to instrument “one above, one below” the fractured vertebrae (2 motion segments), decreasing the exposure, preserving fusion levels, and making instrumentation removal less necessary. [9, 10] such a construct puts higher loads on the pedicles and pedicle screws, which may lead to early implant failure due to pedicle screw bending or breakage or to bone failure with screw loosening or pullout
Summary
Burst fracture in spine is an unstable fracture that often needs surgical stabilization with instrumentational fixation.[1,2,3] Numerous spinal internal fixation implants are available to stabilize the fracture segment using an anterior or a posterior approach.[4,5,6] The goal of any implant is to create and maintain reduction until spinal fusion occurs. [13,14,15,16,17] Biomechanical and clinical data have shown that anterior instrumentation with a graft presents some benefits in SSPI augmentation, including increasing the stiffness of the stabilized segment, increasing the rate of fusion, and decreasing the rate of implant failure. Short-segment pedicle screw instrumentation (SSPI) is used for unstable burst fractures to correct deformity and stabilize the spine for fusion. Pedicle screw loosening, pullout, or breakage often occurs due to the large moment applied during spine motion, leading to poor outcomes. The purpose of this study was to test the ability of a newly designed device, the Trans-Endplate Pedicle Pillar System (TEPPS), to enhance SSPI rigidity and decrease the screw bending moment with a simple posterior approach
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