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. 2021 Jan;30(1):34-49.
doi: 10.1007/s00586-020-06597-z. Epub 2020 Oct 3.

Cross-links in posterior pedicle screw-rod instrumentation of the spine: a systematic review on mechanical, biomechanical, numerical and clinical studies

Frédéric Cornaz #  1   2 , Jonas Widmer #  3   4 , Jess Gerrit Snedeker  3   4 , José Miguel Spirig  3 , Mazda Farshad  3
Affiliations
Free article

Cross-links in posterior pedicle screw-rod instrumentation of the spine: a systematic review on mechanical, biomechanical, numerical and clinical studies

Frédéric Cornaz et al. Eur Spine J. 2021 Jan.
Free article

Abstract

Purpose: Dorsal screw-rod instrumentations are used for a variety of spinal disorders. Cross-links (CL) can be added to such constructs, however, no clear recommendations exist. This study aims to provide an overview of the available evidence on the effectiveness of CL, potentially allowing to formulate recommendations on their use.

Methods: A systematic literature review was performed on PubMed and 37 original articles were included and grouped into mechanical, biomechanical, finite element and clinical studies. The change in range of motion (ROM) was analyzed in mechanical and biomechanical studies, ROM, stiffness and stress distribution were evaluated in finite element studies and clinical outcome parameters were analyzed in clinical studies.

Results: A relative consistent reduction in ROM in axial rotation with CL-augmentation was reported, while minor and less consistent effects were observed in flexion-extension and lateral bending. The use of CLs was clinical beneficial in C1/2 fusion, while the limited clinical studies on other anatomic regions show no significant benefit for CL-augmentation.

Conclusion: While CL provides some additional axial rotation stability in most situations, lateral bending and flexion-extension are less affected. Based on clinical data, CL-augmentation can only be recommended for C1/2 instrumentations, while for other cases, further clinical studies are needed to allow for evidence-based recommendations.

Keywords: Cross-link; Dorsal instrumentation; Spine; Systematic review; Transfixation; Transverse connector.

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References

    1. Zdeblick TA (1993) A prospective, randomized study of lumbar fusion: priliminary results. Spine Phila Pa 1976 18:983–991 - DOI
    1. Pintar FA, Maiman DJ, Yoganandan N et al (1995) Rotational stability of a spinal pedicle screw/rod system. J Spinal Disord 8:49–55. https://doi.org/10.1097/00002517-199502000-00007 - DOI - PubMed
    1. Chutkan NB, Zhou H, Akins JP, Wenger KH (2008) Effects of facetectomy and crosslink augmentation on motion segment flexibility in posterior lumbar interbody fusion. Spine J 33:E828–E835. https://doi.org/10.1097/BRS.0b013e318183bb6d - DOI
    1. O’Brien JR, Dmitriev AE, Yu W et al (2009) Posterior-only stabilization of 2-column and 3-column injuries at the cervicothoracic junction: a biomechanical study. J Spinal Disord Tech 22:340–346. https://doi.org/10.1097/BSD.0b013e31816f68d9 - DOI - PubMed
    1. Kuklo TR, Dmitriev AE, Cardoso MJ et al (2008) Biomechanical contribution of transverse connectors to segmental stability following long segment instrumentation with thoracic pedicle screws. Spine Phila Pa 1976 33:E482–E487. https://doi.org/10.1097/BRS.0b013e31817c64d5 - DOI - PubMed

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