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Does Semi-Rigid Instrumentation Using Both Flexion and Extension Dampening Spacers Truly Provide an Intermediate Level of Stabilization?

DOI: 10.1155/2013/738252

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Abstract:

Conventional posterior dynamic stabilization devices demonstrated a tendency towards highly rigid stabilization approximating that of titanium rods in flexion. In extension, they excessively offload the index segment, making the device as the sole load-bearing structure, with concerns of device failure. The goal of this study was to compare the kinematics and intradiscal pressure of monosegmental stabilization utilizing a new device that incorporates both a flexion and extension dampening spacer to that of rigid internal fixation and a conventional posterior dynamic stabilization device. The hypothesis was the new device would minimize the overloading of adjacent levels compared to rigid and conventional devices which can only bend but not stretch. The biomechanics were compared following injury in a human cadaveric lumbosacral spine under simulated physiological loading conditions. The stabilization with the new posterior dynamic stabilization device significantly reduced motion uniformly in all loading directions, but less so than rigid fixation. The evaluation of adjacent level motion and pressure showed some benefit of the new device when compared to rigid fixation. Posterior dynamic stabilization designs which both bend and stretch showed improved kinematic and load-sharing properties when compared to rigid fixation and when indirectly compared to existing conventional devices without a bumper. 1. Introduction Fusion using rigid pedicle screw-rod instrumentation is a conventional surgical treatment for mechanical back pain due to disc degeneration when nonoperative treatment has failed. In spite of this standard, it is associated with implant-related failures such as screw breakage or loosening. Screw breakage or loosening have been reported in the literature to range from 1% to 11.2% of the screws inserted [1–7]. It has been shown to be affected by a number of factors such as screw design, the number of levels fused, anterior column load-sharing, bone density, the presence of pseudoarthrosis, and its use in burst fractures [3, 4, 8–10]. While in multilevel fusion, bone density and burst fracture applications are more related to patient pathology and indications; all other factors are more dependent on implant design and biomechanics. Anterior column load-sharing is negatively affected by the absence of interbody support and higher stiffness of posterior fixation devices [3, 11]. Adjacent segment degeneration (ASD) has also been recognized as a potential long-term complication of rigidly instrumented fusion [12–17]. While there is some debate

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