A comparative biomechanical study of spinal fixation using the combination spinal rod-plate and transpedicular screw...

A biomechanical study was performed comparing the stiffness and stability of the three-level combination spinal rod-plate and transpedicular screw (CSRP-TPS) fixation system with those of three anterior stabilization constructs that spanned three vertebral levels: iliac strut grafting, polymethylmethacrylate and anterior Harrington rod instrumentation (technique of Siegal et al.), and the Kaneda anterior device. The CSRP-TPS fixation system was also compared with five posterior instrumentation systems that spanned five vertebral levels: Harrington distraction rod instrumentation, segmentally wired Luque rectangular instrumentation, Cotrel-Dubousset transpedicular instrumentation. Steffee transpedicular screws and plates, and R. Roy-Camille plates under conditions of single-level instability. The relative stability of each instrumentation system was compared by mounting the fixation systems on calf spine segments containing five motion segments destabilized by complete L3 anterior corpectomies and L2-L3 and L3-L4 anterior diskectomies to simulate the two-column instability found clinically in spine fractures. Mechanical nondestructive cyclical testing in rotation, axial compression, and flexion was performed on 12 spines. All biomechanical tests were performed on a biaxial servo-controlled MTS 858 Bionix hydraulic materials testing device with a biaxial load cell. Intervertebral displacements between L2 and L4 were continuously recorded utilizing an extensometer with the knife edges placed directly adjacent to the L3 corpectomy defect during testing. This biomechanical study showed that CSRP-TPS instrumentation spanning three vertebral levels could restore the torsional, compressive, and flexural rigidity of the destabilized calf spines to that of the intact calf spines and provided more in vitro stability than either the traditional five-level Harrington distraction rod or the segmentally wired Luque rectangular instrumentation. The greatest torsional rigidity occurred with the five-level Cotrel-Dubousset instrumentation, the five-level Steffee plate and screw system, and the three-level Kaneda anterior device. In axial compression and flexural testing, the three-level CSRP-TPS system provided fixation comparable with the five-level Cotrel-Dubousset instrumentation, the five-level Steffee transpedicular screw and plate system, the five-level R. Roy-Camille plate and screw system, and the three-level Kaneda anterior device. Satisfactory levels of rigidity can be restored by three-level CSRP-TPS instrumentation under conditions of single-level instability in unstable thoracolumbar and lumbar spine fractures.