Abstract
Purpose: The objectives of this study were to determine the effect of posterior instrumentation extension and/or cement augmentation on immediate stabilization of the instrumented level and biomechanical changes adjacent to the spinal instrumentation.
Methods: This study was designed for repeated measures comparison, using 12 T9-L3 human cadaveric segments, to test the effects of posterior rod extension and cement augmentation following T11 corpectomy. The spine was stabilized with a vertebral body replacement device and with posterior instrumentation from T10 to T12. The T12 pedicle tracts were over-drilled to simulate loosened screws in an osteoporotic spine. The T10 screws were not over-drilled but cemented so as to keep the superior segments constant. Flexibility tests were first carried out on the intact specimen, followed by 3 randomized surgical conditions without cement and lastly the 3 conditions after cement augmentation. The 3 conditions were: 1) no posterior extension rods to L1, 2) flexible extension rods, and 3) rigid extension rods. A combined testing/analysis protocol that used both the traditional flexibility method and a hybrid technique [Panjabi 2005] was adopted. Flexibility tests with +/−5 Nm pure moments in flexion-extension, axial rotation and lateral bending were carried out and vertebral bodies’ motion in 3-D were collected. Two-way repeated measures ANOVA analyses were carried out on ROM between cement augmentation (factor 1) and the posterior rod extension (factor 2) on each flexibility test direction. An alpha of 0.05 was chosen. Newman-Keuls post-hoc analyses were carried out to compare between surgical techniques.
Results: Using the flexibility protocol, a reduction in ROMs at the destabilized level was observed with cement augmentation of screws or extension with rigid or flexible posterior rods to adjacent distal level. With the hybrid protocol, ROMs at adjacent level (T12-L1) were reduced with rod extension, but not with cement.
Conclusions: The results of this study suggest that cement augmentation would enhance stabilization, but create possible adjacent level effects due to increased motion and strain, while additional flexible extension rods would reduce biomechanical changes at the level of extension. Funding: 2 Funding Parties: CIHR
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
