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. 2023 Nov;11(6):1335-1345.
doi: 10.1007/s43390-023-00716-8. Epub 2023 Jun 17.

Spinolaminar locking plates improve fixation strength compared to pedicle screws: a biomechanical analysis

Dimitriy G Kondrashov  1   2   3 , Amit S Piple  4 , Victor Ungurean Jr  4 , Adam M Schlauch  5 , Andrea Rowland  5 , Tien Tran  4 , Anton Denisov  6   7   8 , Nikita Zaborovskii  9   10 , Oluwatodimu Richard Raji  11   4
Affiliations

Spinolaminar locking plates improve fixation strength compared to pedicle screws: a biomechanical analysis

Dimitriy G Kondrashov et al. Spine Deform. 2023 Nov.

Abstract

Introduction: Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation.

Methods: A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed.

Results: Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did.

Conclusions: The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.

Keywords: Biomechanics; Instrumentation; Lumbar; Pedicle screw; Pullout; Spinolaminar plate.

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References

    1. Martin BI, Mirza SK, Spina N et al (2019) Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine 44:369–376 - DOI - PubMed
    1. Deng H, Yue JK, Ordaz A et al (2021) Elective lumbar fusion in the United States: national trends in inpatient complications and cost from 2002–2014. J Neurosurg Sci 65:503–512 - DOI - PubMed
    1. Deyo RA, Mirza SK, Martin BI (2011) Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 306:1088 - DOI - PubMed
    1. Hirano T, Hasegawa K, Washio T, Hara T et al (1998) Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord 11:493–497 - DOI - PubMed
    1. Weiser L, Huber G, Sellenschloh K et al (2017) Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. Eur Spine J 26:2891–2897 - DOI - PubMed