TY - JOUR

T1 - Spinolaminar locking plates improve fixation strength compared to pedicle screws

T2 - a biomechanical analysis

AU - Kondrashov, Dimitriy G

AU - Piple, Amit S

AU - Ungurean, Victor

AU - Schlauch, Adam M

AU - Rowland, Andrea

AU - Tran, Tien

AU - Denisov, Anton

AU - Zaborovskii, Nikita

AU - Raji, Oluwatodimu Richard

N1 - © 2023. The Author(s), under exclusive licence to Scoliosis Research Society.

PY - 2023/11

Y1 - 2023/11

N2 - INTRODUCTION: Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation.METHODS: A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed.RESULTS: Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did.CONCLUSIONS: The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.

AB - INTRODUCTION: Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation.METHODS: A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed.RESULTS: Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did.CONCLUSIONS: The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.

KW - Biomechanics

KW - Instrumentation

KW - Lumbar

KW - Pedicle screw

KW - Pullout

KW - Spinolaminar plate

UR - https://www.mendeley.com/catalogue/4ce24b85-b6ee-3a96-bdcc-9f715c87168d/

U2 - 10.1007/s43390-023-00716-8

DO - 10.1007/s43390-023-00716-8

M3 - Article

C2 - 37329420

VL - 11

SP - 1335

EP - 1345

JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

IS - 6

ER -