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Biomechanical Analysis of Wide Posterior Releases Compared With Inferior Facetectomy and Discectomy in the Thoracolumbar and Lumbar Spine

  • Biomechanics
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Abstract

Study Design

In vitro biomechanical analysis.

Objectives

Compare the destabilizing effects of anterior discectomy to posterior spinal releases.

Summary of Background Data

Posterior release and pedicle screw fixation has become the accepted form of treatment for lumbar and thoracolumbar pediatric scoliotic spinal deformity. A biomechanical evaluation of posterior releases with comparison to traditional anterior releases has not been reported in the lumbar spine.

Methods

Eleven fresh-frozen human thoracolumbar specimens (T9—L5) were tested by a robotic manipulator (Staubli RX90; moment target of 5.0 Nm, force target of 50 N) in axial rotation (AR), plus lateral and anterior translation (LT and AT). Specimens underwent either sequential anterior release (partial and full discectomy) or posterior release (inferior facetectomy and wide posterior release) from T10 to L4. Partial discectomy retained the posterior 50% of disc and posterior longitudinal ligament, whereas full discectomy removed all of the disc and PLL. Wide posterior release included total facetectomy plus ligamentum flavum and spinous process resection.

Results

Inferior facetectomy produced an average increase of 1.5° ± 1.0° (p = .0625), 1.0 ± 0.8 mm (p = .0313), and 0.2 ± 0.3 mm (p =.156) in AR, LT, and AT, respectively. Compared with partial facetectomy, wide posterior release produced an average additional increase of 8.1° ± 4.0° (p = .0312), 2.0 ± 2.2 mm (p = .4062), and 1.1 ± 1.0 mm (p = .0625) in AR, LT, and AT, respectively. Full discectomy produced 201%, 161%, and 153% of the motion relative to wide posterior release in AR, LT, and AT, respectively (p = .0043, .0087, and .0173). Partial discectomy and wide posterior release proved statistically equivalent.

Conclusions

Wide posterior release of the thoracolumbar spine allows significant correction and may be superior to inferior facetectomy in axial rotation. Although complete discectomy with PLL resection would likely allow greater correction, a more clinically realistic partial discectomy confers similar corrective potential in vitro compared with wide posterior release.

Level of Evidence

Not applicable.

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References

  1. Burton DC, Asher MA, Lai SM. Patient-based outcomes analysis of patients with single torsion thoracolumbar-lumbar scoliosis treated with anterior or posterior instrumentation: an average 5- to 9-year follow-up study. Spine (Phila Pa 1976) 2002;27:2363–7.

    Article  Google Scholar 

  2. Geck MJ, Rinella A, Hawthorne D, et al. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine (Phila Pa 1976) 2009;34:1942–51.

    Article  Google Scholar 

  3. Barr SJ, Schuette AM, Emans JB. Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1997;22:1369–79.

    Article  CAS  Google Scholar 

  4. Hamill CL, Lenke LG, Bridwell KH, et al. The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted? Spine (Phila Pa 1976) 1996;21:1241–9.

    Article  CAS  Google Scholar 

  5. Hee HT, Yu ZR, Wong HK. Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine (Phila Pa 1976) 2007;32:1533–42.

    Article  Google Scholar 

  6. Halm H, Niemeyer T, Link T, Liljenqvist U. Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J 2000;9:191–7.

    Article  CAS  Google Scholar 

  7. Andras LM, Joiner ER, McCarthy RE, et al. Growing rods versus shilla growth guidance: better Cobb angle correction and T1-S1 length increase but more surgeries. Spine Deform 2015;3:246–52.

    Article  Google Scholar 

  8. Shufflebarger HL, Clark CE. Effect of wide posterior release on correction in adolescent idiopathic scoliosis. J Pediatr Orthop B 1998;7:117–23.

    Article  CAS  Google Scholar 

  9. Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech 2007;20:586–93.

    Article  Google Scholar 

  10. Wang C, Bell K, McClincy M, et al. Biomechanical comparison of Ponte osteotomy and discectomy. Spine (Phila Pa 1976) 2015;40: E141–5.

    Article  Google Scholar 

  11. Wollowick AL, Farrelly EE, Meyers K, et al. Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines. Spine (Phila Pa 1976) 2013;38:1540–5.

    Article  Google Scholar 

  12. Wiemann J, Durrani S, Bosch P. The effect of posterior spinal releases on axial correction torque: a cadaver study. J Child Orthop 2011;5:109–13.

    Article  Google Scholar 

  13. Sangiorgio SN, Borkowski SL, Bowen RE, et al. Quantification of increase in three-dimensional spine flexibility following sequential Ponte osteotomies in a cadaveric model. Spine Deform 2013;1: 171–8.

    Article  Google Scholar 

  14. Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 1998;7:148–54.

    Article  CAS  Google Scholar 

  15. Bell KM, Hartman RA, Gilbertson LG, Kang JD. In vitro spine testing using a robot-based testing system: comparison of displacement control and hybrid control. J Biomech 2013;46:1663–9.

    Article  Google Scholar 

  16. Bell KM, Oh A, Cook HA, et al. Adaptation of a clinical fixation device for biomechanical testing of the lumbar spine. J Biomech 2018;69:164–8.

    Article  Google Scholar 

  17. Geck MJ, Rinella A, Hawthorne D, et al. Anterior dual rod versus posterior pedicle fixation surgery for the surgical treatment in Lenke 5C adolescent idiopathic scoliosis: a multicenter, matched case analysis of 42 patients. Spine Deform 2013;1:217–22.

    Article  Google Scholar 

  18. Li M, Ni J, Fang X, et al. Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009;34:1162–6.

    Article  Google Scholar 

  19. Hsu LC, Zucherman J, Tang SC, Leong JC. Dwyer instrumentation in the treatment of adolescent idiopathic scoliosis. J Bone Joint Surg Br 1982;64:536–41.

    Article  CAS  Google Scholar 

  20. Dwyer AF, Newton NC, Sherwood AA. An anterior approach to scoliosis. A preliminary report. Clin Orthop Relat Res 1969;62:192–202.

    Article  CAS  Google Scholar 

  21. Moe JH, Purcell GA, Bradford DS. Zielke instrumentation (VDS) for the correction of spinal curvature. Analysis of results in 66 patients. Clin Orthop Relat Res 1983;180:133–53.

    Google Scholar 

  22. Sweet FA, Lenke LG, Bridwell KH, Blanke KM. Maintaining lumbar lordosis with anterior single solid-rod instrumentation in thoracolumbar and lumbar adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:1655–62.

    Article  CAS  Google Scholar 

  23. Lowe TG, Peters JD. Anterior spinal fusion with Zielke instrumentation for idiopathic scoliosis. A frontal and sagittal curve analysis in 36 patients. Spine (Phila Pa 1976) 1993;18:423–6.

    Article  CAS  Google Scholar 

  24. Liebsch C, Graf N, Appelt K, Wilke HJ. The rib cage stabilizes the human thoracic spine: An in vitro study using stepwise reduction of rib cage structures. PLoS One 2017;12:e0178733.

    Article  Google Scholar 

  25. Janssen MM, de Wilde RF, Kouwenhoven JW, Castelein RM. Experimental animal models in scoliosis research: a review of the literature. Spine J 2011;11:347–58.

    Article  Google Scholar 

  26. McCarthy RE, Sucato D, Turner JL, et al. Shilla growing rods in a caprine animal model: a pilot study. Clin Orthop Relat Res 2010;468:705–10.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University of Pittsburgh Ferguson Laboratory for Orthopaedic Research, 200 Lothrop St., E1658, University of Pittsburgh, 15213, Pittsburgh, PA, USA

    Bryan Rynearson MD, Rahul Ramanathan BS, Marcus Allen BS, Xiangjiang Wang MD, Nicholas Vaudreuil MD, Kevin M. Bell PhD & Patrick Bosch MD

Authors
  1. Bryan Rynearson MD
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  2. Rahul Ramanathan BS
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  3. Marcus Allen BS
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  4. Xiangjiang Wang MD
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  5. Nicholas Vaudreuil MD
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  6. Kevin M. Bell PhD
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  7. Patrick Bosch MD
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Corresponding author

Correspondence to Bryan Rynearson MD.

Additional information

Author disclosures: BR (none), RR (none), MA (none), XW (none), NV (none), KMB (none), PB (none).

IRB Approval: No IRB approval was required or obtained for this work. Regulatory approval was obtained from the Office for Oversight of Anatomic Specimens (CORID#: 687).

Funding: Departmental grant funds were used for this work. No other grants or donations were utilized.

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Rynearson, B., Ramanathan, R., Allen, M. et al. Biomechanical Analysis of Wide Posterior Releases Compared With Inferior Facetectomy and Discectomy in the Thoracolumbar and Lumbar Spine. Spine Deform 7, 404–409 (2019). https://doi.org/10.1016/j.jspd.2018.09.004

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  • DOI: https://doi.org/10.1016/j.jspd.2018.09.004

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