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Biomechanical properties of posterior transpedicular–transdiscal oblique lumbar screw fixation with novel trapezoidal lateral interbody spacer: an in vitro human cadaveric model

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Abstract

Purpose

To investigate biomechanical properties of posterior transpedicular–transdiscal (TPTD) oblique lumbar screw fixation whereby the screw traverses the inferior pedicle across the posterior disc space into the super-adjacent body and lateral trapezoidal interbody spacer.

Methods

Eight fresh–frozen osteoligamentous human cadaveric spines (L1–S1) were tested in flexion–extension (FE), lateral bending (LB), and axial rotation (AR), with pure bending moment set at 7.5 Nm. Surgical constructs included (1) intact spine; (2) bilateral pedicle screw (BPS) fixation at L3–L4; (3) TPTD screw fixation at L3–L4; (4) lateral L3–L4 discectomy; (5) TPTD screw fixation with lateral interbody spacer (TPTD+S); and (6) BPS fixation with lateral interbody spacer (BPS+S). Peak range of motion (ROM) at L3–L4 was normalized to intact for statistical analysis.

Results

In FE and LB, all posterior fixation with or without interbody spacers significantly reduced motion compared with intact and discectomy. BPS and BPS+S provided increased fixation in all planes of motion; significantly reducing FE and LB motion relative to TPTD (p = 0.005, p = 0.002 and p = 0.020, p = 0.004, respectively). In AR, only BPS significantly reduced normalized ROM to intact (p = 0.034); BPS+S provided greater fixation compared with TPTD+S (p = 0.005).

Conclusions

Investigators found less stiffness with TPTD screw fixation than with BPS regardless of immediate stabilization with lateral discectomy and spacer. Clinical use should be decided by required biomechanical performance, difficulty of installation, and extent of paraspinal tissue disruption.

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Acknowledgements

The authors would like to thank Dolores Matthews, MEd, ELS, for contributions in editing the manuscript.

Funding

National Natural Sciences Foundation of China (No. 81501933) and Xinmiao Talent Plan of Zhejiang Province (No. 2014R413053).

Author information

Authors and Affiliations

  1. Department of Spinal Surgery, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, 109 West Xueyuan Road, Wenzhou, 325000, Zhejiang, People’s Republic of China

    Ai-Min Wu & Yong-Long Chi

  2. Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical, Inc., 2560 General Armistead Avenue, Audubon, PA, 19403, USA

    Jonathan A. Harris & Brandon S. Bucklen

  3. School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bosson 718, Philadelphia, PA, 19104, USA

    John C. Hao & Sean M. Jenkins

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  1. Ai-Min Wu
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  2. Jonathan A. Harris
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Corresponding author

Correspondence to Jonathan A. Harris.

Ethics declarations

The authors performed this study in the biomechanical laboratory at Globus Medical, Inc. (GMI), using its six-degrees-of-freedom motion simulator. A-MW and Y-LC have no financial relationships with GMI. A-MW was supported by National Natural Sciences Foundation of China (No. 81501933) and Xinmiao Talent Plan of Zhejiang Province (No. 2014R413053). National Natural Sciences Foundation of China and Xinmiao Talent Plan of Zhejiang Province paid all travel fees but had no role in designing or conducting this study. Funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation. Cadaveric specimens and related materials were provided by GMI, at which JAH and BSB are employees. JCH and SMJ are visiting interns.

Conflict of interest

BSB and JAH are paid employees of Globus Medical, Inc., JCH and SMJ were temporary, hourly paid interns of Globus Medical, Inc., YLC and AMW have nothing to disclose.

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Wu, AM., Harris, J.A., Hao, J.C. et al. Biomechanical properties of posterior transpedicular–transdiscal oblique lumbar screw fixation with novel trapezoidal lateral interbody spacer: an in vitro human cadaveric model. Eur Spine J 26, 2873–2882 (2017). https://doi.org/10.1007/s00586-017-5050-6

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  • DOI: https://doi.org/10.1007/s00586-017-5050-6

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