• World Neurosurg · Apr 2022

    Optimizing Cervicothoracic Junction Biomechanics after C7 Pedicle Subtraction Osteotomy: A Cadaveric Study of Stability and Rod Strain.

    • Jakub Godzik, Jennifer N Lehrman, S Harrison Farber, Bernardo de Andrada Pereira, SawaAnna G UAGUSpinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Christopher P Ames, Heiko Koller, Kevin Lee, Jay D Turner, and Brian P Kelly.
    • Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
    • World Neurosurg. 2022 Apr 1; 160: e278-e287.

    ObjectiveTo compare biomechanical stability and rod strain among uniform rod (UR), tapered rod (TR), and UR+accessory rod (AR) constructs in a human cadaveric C7 pedicle subtraction osteotomy (PSO) model of cervical deformity correction.MethodsFourteen human cadaveric C2-T4 specimens were divided into 2 statistically equivalent groups. Specimens were instrumented from C2 to T3, and a 25° PSO was performed at C7. Group 1 was instrumented with 3.5-mm to 5.5-mm titanium TRs, and group 2 received 4.0-mm titanium URs. The UR group was also tested with lateral 4.0-mm titanium ARs (UR+AR) at C5-T2. All conditions were tested with 2.0 Nm pure moment and 70 N compressive load. Intervertebral range of motion (ROM) and posterior rod strain (pRS) were measured at C2-C3, T2-T3, and the PSO level. Statistical comparisons used 1-way analysis of variance.ResultsROM was significantly reduced in the TR versus UR construct for right axial rotation (P = 0.04) at the PSO level; ROM with TR was significantly greater than with UR and UR+AR in compression (P ≤ 0.02). At the PSO level, pRS was significantly greater in TR than in UR+AR in flexion, extension, and right axial rotation (P ≤ 0.02). At T2/3, pRS was higher in UR than TR in left axial rotation (P = 0.003).ConclusionsC7 PSO is highly destabilizing. Maximal rod strain was concentrated across the PSO and the cranial fixation site. TR provided higher stability than did UR in 1 direction of movement; however, UR+AR provided the greatest reduction of pRS.Copyright © 2022 Elsevier Inc. All rights reserved.

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