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Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study

BACKGROUND: Anterior bone grafts are used as struts to reconstruct the anterior column of the spine in kyphosis or following injury. An incomplete fusion can lead to later correction losses and compromise further healing. Despite the different stabilizing techniques that have evolved, from posterior...

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Autores principales: Pizanis, Antonius, Holstein, Jörg H, Vossen, Felix, Burkhardt, Markus, Pohlemann, Tim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766234/
https://www.ncbi.nlm.nih.gov/pubmed/23971712
http://dx.doi.org/10.1186/1471-2474-14-254
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author Pizanis, Antonius
Holstein, Jörg H
Vossen, Felix
Burkhardt, Markus
Pohlemann, Tim
author_facet Pizanis, Antonius
Holstein, Jörg H
Vossen, Felix
Burkhardt, Markus
Pohlemann, Tim
author_sort Pizanis, Antonius
collection PubMed
description BACKGROUND: Anterior bone grafts are used as struts to reconstruct the anterior column of the spine in kyphosis or following injury. An incomplete fusion can lead to later correction losses and compromise further healing. Despite the different stabilizing techniques that have evolved, from posterior or anterior fixating implants to combined anterior/posterior instrumentation, graft pseudarthrosis rates remain an important concern. Furthermore, the need for additional anterior implant fixation is still controversial. In this bench-top study, we focused on the graft-bone interface under various conditions, using two simulated spinal injury models and common surgical fixation techniques to investigate the effect of implant-mediated compression and contact on the anterior graft. METHODS: Calf spines were stabilised with posterior internal fixators. The wooden blocks as substitutes for strut grafts were impacted using a “pressfit” technique and pressure-sensitive films placed at the interface between the vertebral bone and the graft to record the compression force and the contact area with various stabilization techniques. Compression was achieved either with posterior internal fixator alone or with an additional anterior implant. The importance of concomitant ligament damage was also considered using two simulated injury models: pure compression Magerl/AO fracture type A or rotation/translation fracture type C models. RESULTS: In type A injury models, 1 mm-oversized grafts for impaction grafting provided good compression and fair contact areas that were both markedly increased by the use of additional compressing anterior rods or by shortening the posterior fixator construct. Anterior instrumentation by itself had similar effects. For type C injuries, dramatic differences were observed between the techniques, as there was a net decrease in compression and an inadequate contact on the graft occurred in this model. Under these circumstances, both compression and the contact area on graft could only be maintained at high levels with the use of additional anterior rods. CONCLUSIONS: Under experimental conditions, we observed that ligamentous injury following type C fracture has a negative influence on the compression and contact area of anterior interbody bone grafts when only an internal fixator is used for stabilization. Because of the loss of tension banding effects in type C injuries, an additional anterior compressing implant can be beneficial to restore both compression to and contact on the strut graft.
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spelling pubmed-37662342013-09-08 Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study Pizanis, Antonius Holstein, Jörg H Vossen, Felix Burkhardt, Markus Pohlemann, Tim BMC Musculoskelet Disord Research Article BACKGROUND: Anterior bone grafts are used as struts to reconstruct the anterior column of the spine in kyphosis or following injury. An incomplete fusion can lead to later correction losses and compromise further healing. Despite the different stabilizing techniques that have evolved, from posterior or anterior fixating implants to combined anterior/posterior instrumentation, graft pseudarthrosis rates remain an important concern. Furthermore, the need for additional anterior implant fixation is still controversial. In this bench-top study, we focused on the graft-bone interface under various conditions, using two simulated spinal injury models and common surgical fixation techniques to investigate the effect of implant-mediated compression and contact on the anterior graft. METHODS: Calf spines were stabilised with posterior internal fixators. The wooden blocks as substitutes for strut grafts were impacted using a “pressfit” technique and pressure-sensitive films placed at the interface between the vertebral bone and the graft to record the compression force and the contact area with various stabilization techniques. Compression was achieved either with posterior internal fixator alone or with an additional anterior implant. The importance of concomitant ligament damage was also considered using two simulated injury models: pure compression Magerl/AO fracture type A or rotation/translation fracture type C models. RESULTS: In type A injury models, 1 mm-oversized grafts for impaction grafting provided good compression and fair contact areas that were both markedly increased by the use of additional compressing anterior rods or by shortening the posterior fixator construct. Anterior instrumentation by itself had similar effects. For type C injuries, dramatic differences were observed between the techniques, as there was a net decrease in compression and an inadequate contact on the graft occurred in this model. Under these circumstances, both compression and the contact area on graft could only be maintained at high levels with the use of additional anterior rods. CONCLUSIONS: Under experimental conditions, we observed that ligamentous injury following type C fracture has a negative influence on the compression and contact area of anterior interbody bone grafts when only an internal fixator is used for stabilization. Because of the loss of tension banding effects in type C injuries, an additional anterior compressing implant can be beneficial to restore both compression to and contact on the strut graft. BioMed Central 2013-08-26 /pmc/articles/PMC3766234/ /pubmed/23971712 http://dx.doi.org/10.1186/1471-2474-14-254 Text en Copyright © 2013 Pizanis et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Pizanis, Antonius
Holstein, Jörg H
Vossen, Felix
Burkhardt, Markus
Pohlemann, Tim
Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title_full Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title_fullStr Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title_full_unstemmed Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title_short Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
title_sort compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766234/
https://www.ncbi.nlm.nih.gov/pubmed/23971712
http://dx.doi.org/10.1186/1471-2474-14-254
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