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Biomechanical Analysis of an Interspinous Process Fixation Device with In Situ Shortening Capabilities: Does Spinous

Christopher Wagener1, Anup Gandhi2, Chris Ferry3

  • 1Coordinated Health Systems, Bethlehem, Pennsylvania, USA.

World Neurosurgery
|September 6, 2020
PubMed
Summary

In situ shortening of an adjustable interspinous process fixation (ISPF) device enhances spinal stabilization. This biomechanical study demonstrates improved segmental stability with the shortened ISPF compared to static configurations.

Keywords:
BiomechanicsCadavericInterspinous process fixationLateral lumbar interbody fusionPedicle screw fixationPosterior fixation

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Area of Science:

  • Spine Biomechanics
  • Spinal Fusion
  • Orthopedic Devices

Background:

  • Interspinous process fixation (ISPF) devices are utilized in spinal fusion procedures.
  • Understanding the biomechanical effects of ISPF, particularly adjustable devices, is crucial for optimizing fusion outcomes.
  • Spinous process compression is a key mechanism for ISPF devices.

Purpose of the Study:

  • To evaluate the biomechanical impact of in situ shortening of a novel interspinous process fixation (ISPF) device.
  • To compare the segmental stabilization provided by ISPF in various configurations, including stand-alone and combined with lateral lumbar interbody fusion (LLIF).
  • To assess the influence of ISPF on segmental range of motion (ROM) and lordosis.

Main Methods:

  • Seven lumbar cadaveric spines (L1-L4) were tested under intact and instrumented conditions.
  • Constructs included stand-alone ISPF (neutral and shortened), LLIF + ISPF (neutral and shortened), LLIF + unilateral pedicle screw fixation (UPSF), and LLIF + bilateral pedicle screw fixation (BPSF).
  • A 7.5-Nm moment was applied to measure segmental ROM and lordosis in flexion/extension, lateral bending, and axial rotation.

Main Results:

  • All constructs significantly reduced flexion/extension ROM compared to the intact state (P < 0.01).
  • LLIF + ISPF (neutral and shortened) demonstrated significantly greater ROM reduction than stand-alone ISPF (P < 0.01).
  • LLIF + BPSF showed the most significant reductions in all tested ROM (flexion/extension, lateral bending, axial rotation) compared to other constructs (P < 0.01).

Conclusions:

  • In situ shortening of an adjustable ISPF device may enhance segmental stabilization compared to static ISPF.
  • Combined LLIF and ISPF constructs, particularly with bilateral pedicle screw fixation, offer superior spinal stabilization.
  • Adjustable ISPF technology holds potential for improving biomechanical support in spinal fusion.