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Pedicle Subtraction Osteotomy Construct Optimization: A Cadaveric Study of Various Multirod and Interbody
Bernardo de Andrada Pereira1, Jakub Godzik2, Jennifer N Lehrman1
1Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Spine
|February 1, 2022
Summary
Supplemental rods in lumbar fusion reduce motion, but satellite rods (SRs) may increase screw strain and rod failure risk compared to accessory rods (ARs). Lateral lumbar interbody fusion (LLIF) offers greater sagittal stability than transforaminal lumbar interbody fusion (TLIF).
Area of Science:
- Spine biomechanics
- Spinal fusion techniques
- Orthopedic surgery
Background:
- Supplemental rod configurations and anterior column support are crucial for enhancing biomechanical stability in lumbar fusion.
- Understanding the impact of different supplemental rod designs on construct performance is essential for optimizing surgical outcomes.
Purpose of the Study:
- To compare the biomechanical performance of pedicle subtraction osteotomy (PSO) constructs with different supplemental rod configurations (2-rod, 4-rod with accessory rods, 4-rod with satellite rods).
- To evaluate the influence of transforaminal lumbar interbody fusion (TLIF) versus lateral lumbar interbody fusion (LLIF) on construct stability.
Main Methods:
- Fourteen cadaveric lumbar spine specimens underwent PSO with either TLIF or LLIF.
- Constructs were tested under pure moments, comparing intact, pedicle screw/rod, 2-rod, 4-rod accessory rod (AR), and 4-rod satellite rod (SR) configurations.
- Strain gauges measured rod strain, and sacral screw bending moments and range of motion (ROM) were recorded.
Main Results:
- Both AR and SR configurations reduced ROM compared to the 2-rod construct in both TLIF and LLIF groups.
- SR constructs increased sacral screw strain and primary rod bending moments compared to AR constructs.
- LLIF demonstrated greater stability in the sagittal plane, while supplemental rods were more protective of rod strain with TLIF.
Conclusions:
- Supplemental rods effectively reduce motion, but SRs may increase vulnerability to failure due to higher strain on screws and rods.
- LLIF offers superior sagittal stability.
- The choice between AR and SR configurations should consider the trade-off between motion reduction and potential failure risks.
