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Biomechanical comparison of 3 types of transdiscal fixation implants for fixing high-grade L5/S1 spine
Hui-Ling Kerr1, Aaron Gee2, Renan J R Fernandes3
1London Health Science Centre, Victoria Hospital, London, N6A 5W9, Canada; Dept. of Surgery (Div. of Orthopaedic Surgery), Western University, London, N6A 3K7, Canada; Dept. of Trauma and Orthopaedics, Gloucestershire Hospitals NHS Foundation Trust, GL53 7AN, Gloucestershire, UK.
Background Context:
There are several options for the stabilization of high-grade lumbosacral spondylolisthesis including transdiscal screws, the Bohlman technique (transdiscal fibular strut) and the modified Bohlman technique (transdiscal titanium mesh cage). The choice of an optimum construct remains controversial; therefore, we endeavoured to study and compare the biomechanical performance of these 3 techniques.
Purpose:
The aim of this study was to compare 3 types of transdiscal fixation biomechanically in an in vitro porcine lumbar-sacral spine model.
Study Design/Setting:
Porcine cadaveric biomechanical study.
Methods:
18 complete lumbar-sacral porcine spines were split into 3 repair groups, transdiscal screws (TS), Bohlman technique, and a modified Bohlman technique (MBT). Range of motion (L3 - S1) was measured in an intact and repaired state for flexion, extension, left/right lateral bending, and left/right torsion. To recreate a high-grade lumbosacral spondylolisthesis a bilateral L5/S1 facetectomy, removing the intervertebral disc completely, and the L5 body was displaced 50%-60% over the sacral promontory. Results were analyzed and compared to intact baseline measurements. Standard quasi-static moments (5 Nm) were applied in all modes.
Results:
All range of motion (ROM) were in reference to intact baseline values. TS had the lowest ROM in all modes (p=.006-.495). Statistical difference was found only in extension for TS vs. BT (p=.011) and TS vs. MBT (p=.014). No bone or implant failures occurred.
Conclusion:
TS provided the lowest ROM in all modes of loading compared to Bohlman technique and MBT. Our study indicates that TS results in the most biomechanically stable construct.
Clinical Significance:
Knowledge of the biomechanical attributes of various constructs could aid physicians in choosing a surgical construct for their patients.
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