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01-09-2018 | Original Article

Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy

Authors: Luigi La Barbera, Ph.D., Marco Brayda-Bruno, Christian Liebsch, Tomaso Villa, Andrea Luca, Fabio Galbusera, Hans-Joachim Wilke

Published in: European Spine Journal | Issue 9/2018

Abstract

Purpose

To investigate the effect of anterior interbody cages, accessory and satellite rods usage on primary stability and rod strains for PSO stabilization.

Methods

Seven human cadaveric spine segments (T12-S1) underwent PSO at L4 with posterior fixation from L2 to S1. In vitro flexibility tests were performed under pure moments in flexion/extension (FE), lateral bending (LB) and axial rotation (AR) to determine the range of motion, while measuring the strains on the primary rods with strain gauge rosettes. Six constructs with 2, 3 and 4 rods, with and without interbody cages implantation adjacent to the PSO site, were compared.

Results

All constructs had comparable effects in reducing spine kinematics compared to the intact condition (− 94% in FE and LB; − 80% in AR). Supplementation of 2 rods with lateral accessory rods (4 rods) was the most effective strategy in minimizing primary rod strains, particularly when coupled to cages (p ≤ 0.005; − 50% in FE, − 42% in AR and − 11% in LB); even without cages, the strains were significantly reduced (p ≤ 0.009; − 26%, − 37%, − 9%). The addition of a central satellite rod with laminar hooks (3 rods) effectively reduced rod strains in FE (p ≤ 0.005; − 30%) only in combination with cages.

Conclusions

The study supports the current clinical practice providing a strong biomechanical rationale to recommend 4-rod constructs based on accessory rods combined with cages adjacent to PSO site. Although weaker, the usage of accessory rods without cages and of a central satellite rod with hooks in combination with interbody spacers may also be justified.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

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Title: Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy
Authors: Luigi La Barbera, Ph.D.
Marco Brayda-Bruno
Christian Liebsch
Tomaso Villa
Andrea Luca
Fabio Galbusera
Hans-Joachim Wilke
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5623-z

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Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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