Biomechanical Analysis of a Pedicle Screw-Rod System with a Novel Cross-Link Configuration

• Main Authors: Yasuhiro Nakajima, Masahito Hara, Daisuke Umebayashi, Shoichi Haimoto, Yu Yamamoto, Yusuke Nishimura, Toshihiko Wakabayashi
• Format: Article
• Language: English
• Published: Korean Spine Society 2016-12-01
• Series: Asian Spine Journal
• Subjects: Cross-link; Spinous process; Biomechanics; Spinal fusion; Pedicle screw-rod
• Online Access: http://www.asianspinejournal.org/upload/pdf/asj-10-993.pdf

Study DesignThe strength effects of a pedicle screw-rod system supplemented with a novel cross-link configuration were biomechanically evaluated in porcine spines.PurposeTo assess the biomechanical differences between a conventional cross-link pedicle screw-rod system versus a novel cross-link instrumentation, and to determine the effect of the cross-links.Overview of LiteratureTransverse cross-link systems affect torsional rigidity, but are thought to have little impact on the sagittal motion of spinal constructs. We tested the strength effects in pullout and flexion-compression tests of novel cross-link pedicle screw constructs using porcine thoracic and lumbar vertebrae.MethodsFive matched thoracic and lumbar vertebral segments from 15 porcine spines were instrumented with 5.0-mm pedicle screws, which were then connected with 6.0-mm rods after partial corpectomy in the middle vertebral body. The forces required for construct failure in pullout and flexion-compression tests were examined in a randomized manner for three different cross-link configurations: un-cross-link control, conventional cross-link, and cross-link passing through the base of the spinous process. Statistical comparisons of strength data were analyzed using Student's t-tests.ResultsThe spinous process group required a significantly greater pullout force for construct failure than the control group (p=0.036). No difference was found between the control and cross-link groups, or the cross-link and spinous process groups in pullout testing. In flexion-compression testing, the spinous processes group required significantly greater forces for construct failure than the control and cross-link groups (p<0.001 and p=0.003, respectively). However, there was no difference between the control and cross-link groups.ConclusionsA novel cross-link configuration that features cross-link devices passing through the base of the spinous processes increased the mechanical resistance in pullout and flexion-compression testing compared to un-cross-link constructs. This configuration provided more resistance to middle-column damage under flexion-compression testing than conventional cross-link configuration.