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An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction

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Abstract

Purpose

To evaluate the motion-preserving properties of vertebral body tethering with varying cord/screw constructs and cord thicknesses in cadaveric thoracolumbar spines.

Methods

In vitro flexibility tests were performed on six fresh-frozen human cadaveric spines (T1-L5) (2 M, 4F) with a median age of 63 (59-to-80). An ± 8 Nm load was applied to determine range of motion (ROM) in flexion–extension (FE), lateral bending (LB), and axial rotation (AR) in the thoracic and lumbar spine. Specimens were tested with screws (T5-L4) and without cords. Single (4.0 mm and 5.0 mm) and double (4.0 mm) cord constructs were sequentially tensioned to 100 N and tested: (1) Single 4.0 mm and (2) 5.0 mm cords (T5-T12); (3) Double 4.0 mm cords (T5-12); (4) Single 4.0 mm and (5) 5.0 mm cord (T12-L4); (6) Double 4.0 mm cords (T12-L4).

Results

In the thoracic spine (T5-T12), 4.0–5.0 mm single-cord constructs showed slight reductions in FE and 27–33% reductions in LB compared to intact, while double-cord constructs showed reductions of 24% and 40%, respectively. In the lumbar spine (T12-L4), double-cord constructs had greater reductions in FE (24%), LB (74%), and AR (25%) compared to intact, while single-cord constructs exhibited reductions of 2–4%, 68–69%, and 19–20%, respectively.

Conclusions

The present biomechanical study found similar motion for 4.0–5.0 mm single-cord constructs and the least motion for double-cord constructs in the thoracic and lumbar spine suggesting that larger diameter 5.0 mm cords may be a more promising motion-preserving option, due to their increased durability compared to smaller cords. Future clinical studies are necessary to determine the impact of these findings on patient outcomes.

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Funding

Funding for this study was provided by Globus Medical, Inc. (GMI).

Author information

Authors and Affiliations

  1. Eifelklinik St. Brigida, Simmerath, Germany

    Per Trobisch

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

    Jonathan M. Mahoney, Emily K. Eichenlaub, Dhara B. Amin, Joshua P. McGuckin & Brandon S. Bucklen

  3. Institute for Spine and Scoliosis, Lawrenceville, NJ, USA

    Christopher L. Antonacci, Laury Cuddihy, M. Darryl Antonacci & Randal R. Betz

  4. School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA , USA

    Dominic Razo-Castaneda & Mattan R. Orbach

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  1. Per Trobisch
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Correspondence to Joshua P. McGuckin.

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Conflict of interest

PDT receives consulting fees from GMI and Stryker Spine, and lecture fees from ZimVie and Triaspine. RRB receives royalties from GMI, DePuy Synthes Spine, SpineGuard, Thieme Medical Publishers; Speakers bureau payments from GMI and DePuy Synthes Spine; Consulting fees from GMI, DePuy Synthes Spine, SpineGuard, SpineWelding, Addivation, and Orthopediatric Corp and stock options from SpineGuard, SpineWelding, Orthopediatric Corp, Abyrx, Electrocore, H-CYTE, Life Unit, Molecular Surface Technologies, and Orthobond. RRB is also on the Life Unit and Molecular Surface Technologies boards and is the co-owner of NOFUSCO. CLA, LC, DRC, MRO, and MDA have no disclosures to report. EKE, JMM, DBA, JPM, and BSB are paid employees of GMI. JMM, JPM, and BSM also receive stock options from GMI.

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Appendix

Appendix

See Table 4 and 5

Table 4 Statistical comparisons between ROM of thoracic and lumbar constructs in FE, LB, and AR
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Table 5 p values for ROM comparisons between thoracic, lumbar, and thoracolumbar constructs in each direction: flexion (Flex), extension (Ext), left and right LB, and left and right AR
Full size table

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Trobisch, P., Mahoney, J.M., Eichenlaub, E.K. et al. An investigation of range of motion preservation in fusionless anterior double screw and cord constructs for scoliosis correction. Eur Spine J 32, 1173–1186 (2023). https://doi.org/10.1007/s00586-023-07608-5

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