Objective Our study aimed to compare the posterior interposition technique against the posterolateral transosseous technique in the same cadaver specimens.
Methods Computer and cadaver models of 2 fixation techniques were developed. The computer model was constructed to analyze bone volume removed during implant placement and the bony surface area available for fusion. The cadaver model included quasi-static multidirectional bending flexibility and dynamic fatigue loading. Relative motions between the sacrum and ilium were measured intact, after joint destabilization, after fixation with direct-posterior and posterolateral techniques, and after 18,500 cycles of fatigue loading. Relative positions between each implant and the sacrum and ilium were measured after fixation and fatigue loading to ascertain the quality of the bone-implant interface. The 2 techniques were randomized to the left and right sacroiliac joints of the same cadavers.
Results The posterior interposition technique removed less bone volume and facilitated a larger surface area available for bony fusion. Posterior interposition significantly reduced the nutation/counternutation motion of the sacroiliac joint (42% ± 8%) and reduced it more than the posterolateral transosseous technique (14% ± 4%). Upon fatigue loading, the posterior interposition implant maintained the bone-implant interface across all specimens, while the posterolateral transosseous implant migrated or subsided in 20%–50% of specimens.
Conclusion Posterior interposition fixation of the sacroiliac joint reduces joint motion. The amount of fixation from the posterior technique is superior and more durable than the amount of fixation achieved by the posterolateral technique.
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Objective The high mechanical stress zone at the sudden transition from a rigid to flexible region is involved in proximal junctional kyphosis (PJK) physiopathology. We evaluated the biomechanical performance of polyetheretherketone (PEEK) rods used as a nontraditional long semirigid transition phase from a long-segment metallic rod construct to the nonfused thoracic spine.
Methods Pure moment range of motion (ROM) tests (7.5 Nm) were performed on 7 cadaveric spine segments followed by compression (200 N). Specimens were tested in the following conditions: (1) intact; (2) T10-pelvis pedicle screws and rods (PSRs); and (3) extending the proximal construct to T6 using PEEK rods (PSR+PEEK). T10–11 rod strain, T9 anterolateral bone strain, and T10 screw bending moments were analyzed.
Results At the upper instrumented vertebra (UIV)+1, PSR+PEEK versus PSR significantly decreased ROM in flexion (115%, p = 0.02), extension (104%, p = 0.003), left lateral bending (46%, p = 0.02), and right lateral bending (63%, p = 0.008). Also, at UIV+1, PSR+PEEK versus intact significantly decreased ROM in flexion (111%, p = 0.01) and extension (105%, p = 0.003). The UIV+1 anterior column bone strain was significantly reduced with PSR+PEEK versus PSR during right lateral bending (p = 0.02). Rod strain polarities reversed with PEEK rods in all loading directions except compression.
Conclusion Extending a long-segment construct using PEEK rods caused a decrease in adjacent-level hypermobility as a consequence of long-segment immobilization and also redistributed the strain on the UIV and adjacent levels, which might contribute to PJK physiopathology. Further studies are necessary to observe the clinical outcomes of this technique.
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