Related Experiment Video
Updated: Jan 19, 2026
A Minimally Invasive Model to Analyze Endochondral Fracture Healing in Mice Under Standardized Biomechanical Conditions
Published on: March 22, 2018
Optimizing biomechanics of anterior column realignment for minimally invasive deformity correction
Jakub Godzik1, Bernardo de Andrada Pereira2, Anna G U S Newcomb2
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA.
Background Context:
Anterior column realignment (ACR) is a powerful but destabilizing minimally invasive technique for sagittal deformity correction. Optimal biomechanical design of the ACR construct is unknown.
Purpose:
Evaluate the effect of ACR design on radiographic lordosis, range of motion (ROM) stability, and rod strain (RS) in a cadaveric model.
Study Design/Setting:
Cadaveric biomechanical study.
Patient Sample:
Seven fresh-frozen lumbar spine cadaveric specimens (T12-sacrum) underwent ACR at L3-L4 with a 30° implant.
Outcome Measures:
Primary outcome measure of interest was maximum segmental lordosis measured using lateral radiograph. Secondary outcomes were ROM stability and posterior RS at L3/4.
Methods:
Effect of grade 1 and grade 2 osteotomies with single-screw anterolateral fixation (1XLP) or 2-screw anterolateral fixation (2XLP) on lordosis was determined radiographically. Nondestructive flexibility tests were used to assess ROM and RS at L3-L4 in flexion, extension, lateral bending, and axial rotation. Conditions included (1) intact, (2) pedicle screw fixation and 2 rods (2R), (3) ACR+1XLP with 2R, (4) ACR+2XLP+2R, (5) ACR+1XLP with 4 rods (4R) (+4R), and (6) ACR+2XLP+4R.
Results:
Segmental lordosis was similar between ACR+1XLP and ACR+2XLP (p>.28). ACR+1XLP+2R was significantly less stable than all other conditions in flexion, extension, and axial rotation (p<.014); however, adding an extra screw improved stability to levels equal to 4R conditions (p>.36). Adding 4R to ACR+1XLP reduced RS in all directions of loading (p<.048), whereas adding a second screw did not (p>.12). There was no difference in strain between ACR+1XLP+4R and ACR+2XLP+4R (p>.55).
Conclusions:
For maximum stability, ACR constructs should contain either fixation into both vertebral bodies (2XLP) or accessory rods (4R). 2XLP can be used without compromising the maximal achievable lordosis but does not provide the same RS reduction as 4R.
Clinical Significance:
ACR is a highly destabilizing technique that is increasingly being used for minimally invasive deformity correction. These biomechanical data will help clinicians optimize ACR construct design.
Related Concept Videos
06:41A Minimally Invasive Model to Analyze Endochondral Fracture Healing in Mice Under Standardized Biomechanical Conditions
06:46Optimized Minimally Invasive Transscleral Subretinal Injection Technique in Mouse
06:45Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
11:58Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
04:42Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
04:57Prone Lateral Minimally Invasive Retropleural Corpectomy Using a Rotatable Radiolucent Jackson Table