Transverse connectors providing increased stability to the cervical spine rod-screw construct: An in vitro human cadaveric study. Laboratory investigation

Miranda N. Shaw, Etienne P. Morel, P. Andrew Utter, Yazeed M. Gussous, Lise Ginoux, Lawrence J. Berglund, Ralph Gay, William E. Krauss

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Object. The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. Methods. Eleven human cadaveric cervical spines (C2-T1) were used to examine the effect of adding connectors to a C3-7 rod-screw construct in 3 models of instability: 1) C3-6 wide laminectomy, 2) wide laminectomy and 50% foraminotomy at C4-5 and C5-6, and 3) wide laminectomy with full medial to lateral foraminotomy. Following each destabilization procedure, specimens were tested with no TC, 1 TC between the C-5 screws, and 2 TCs between the C-4 and C-6 screws. Testing of the connectors was conducted in random order. Specimens were subjected to ± 2 Nm of torque in flexion and extension, lateral bending, and axial rotation. Range of motion was determined for each experimental condition. Statistical comparisons were made between the destabilized and intact conditions, and between the addition of TCs and the absence of TCs. Results. The progressive destabilization procedures significantly increased motion. The addition of TCs did not significantly change motion in flexion and extension. Lateral bending was significantly decreased with 2 connectors, but not with 1 connector. The greatest effect was on axial rotation. In general, 2 TCs were more restrictive than 1 TC, and decreased motion 10% more than fixation alone. Conclusions. Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.

Original languageEnglish (US)
Pages (from-to)719-725
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume14
Issue number6
DOIs
StatePublished - Jun 2011

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Laminectomy
Foraminotomy
Spine
Torque
Articular Range of Motion
In Vitro Techniques

Keywords

  • Biomechanics
  • Cervical spine fusion
  • Lateral mass fixation
  • Transverse connector

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Transverse connectors providing increased stability to the cervical spine rod-screw construct : An in vitro human cadaveric study. Laboratory investigation. / Shaw, Miranda N.; Morel, Etienne P.; Utter, P. Andrew; Gussous, Yazeed M.; Ginoux, Lise; Berglund, Lawrence J.; Gay, Ralph; Krauss, William E.

In: Journal of Neurosurgery: Spine, Vol. 14, No. 6, 06.2011, p. 719-725.

Research output: Contribution to journalArticle

Shaw, Miranda N. ; Morel, Etienne P. ; Utter, P. Andrew ; Gussous, Yazeed M. ; Ginoux, Lise ; Berglund, Lawrence J. ; Gay, Ralph ; Krauss, William E. / Transverse connectors providing increased stability to the cervical spine rod-screw construct : An in vitro human cadaveric study. Laboratory investigation. In: Journal of Neurosurgery: Spine. 2011 ; Vol. 14, No. 6. pp. 719-725.
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abstract = "Object. The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. Methods. Eleven human cadaveric cervical spines (C2-T1) were used to examine the effect of adding connectors to a C3-7 rod-screw construct in 3 models of instability: 1) C3-6 wide laminectomy, 2) wide laminectomy and 50{\%} foraminotomy at C4-5 and C5-6, and 3) wide laminectomy with full medial to lateral foraminotomy. Following each destabilization procedure, specimens were tested with no TC, 1 TC between the C-5 screws, and 2 TCs between the C-4 and C-6 screws. Testing of the connectors was conducted in random order. Specimens were subjected to ± 2 Nm of torque in flexion and extension, lateral bending, and axial rotation. Range of motion was determined for each experimental condition. Statistical comparisons were made between the destabilized and intact conditions, and between the addition of TCs and the absence of TCs. Results. The progressive destabilization procedures significantly increased motion. The addition of TCs did not significantly change motion in flexion and extension. Lateral bending was significantly decreased with 2 connectors, but not with 1 connector. The greatest effect was on axial rotation. In general, 2 TCs were more restrictive than 1 TC, and decreased motion 10{\%} more than fixation alone. Conclusions. Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.",
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T2 - An in vitro human cadaveric study. Laboratory investigation

AU - Shaw, Miranda N.

AU - Morel, Etienne P.

AU - Utter, P. Andrew

AU - Gussous, Yazeed M.

AU - Ginoux, Lise

AU - Berglund, Lawrence J.

AU - Gay, Ralph

AU - Krauss, William E.

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N2 - Object. The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. Methods. Eleven human cadaveric cervical spines (C2-T1) were used to examine the effect of adding connectors to a C3-7 rod-screw construct in 3 models of instability: 1) C3-6 wide laminectomy, 2) wide laminectomy and 50% foraminotomy at C4-5 and C5-6, and 3) wide laminectomy with full medial to lateral foraminotomy. Following each destabilization procedure, specimens were tested with no TC, 1 TC between the C-5 screws, and 2 TCs between the C-4 and C-6 screws. Testing of the connectors was conducted in random order. Specimens were subjected to ± 2 Nm of torque in flexion and extension, lateral bending, and axial rotation. Range of motion was determined for each experimental condition. Statistical comparisons were made between the destabilized and intact conditions, and between the addition of TCs and the absence of TCs. Results. The progressive destabilization procedures significantly increased motion. The addition of TCs did not significantly change motion in flexion and extension. Lateral bending was significantly decreased with 2 connectors, but not with 1 connector. The greatest effect was on axial rotation. In general, 2 TCs were more restrictive than 1 TC, and decreased motion 10% more than fixation alone. Conclusions. Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.

AB - Object. The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. Methods. Eleven human cadaveric cervical spines (C2-T1) were used to examine the effect of adding connectors to a C3-7 rod-screw construct in 3 models of instability: 1) C3-6 wide laminectomy, 2) wide laminectomy and 50% foraminotomy at C4-5 and C5-6, and 3) wide laminectomy with full medial to lateral foraminotomy. Following each destabilization procedure, specimens were tested with no TC, 1 TC between the C-5 screws, and 2 TCs between the C-4 and C-6 screws. Testing of the connectors was conducted in random order. Specimens were subjected to ± 2 Nm of torque in flexion and extension, lateral bending, and axial rotation. Range of motion was determined for each experimental condition. Statistical comparisons were made between the destabilized and intact conditions, and between the addition of TCs and the absence of TCs. Results. The progressive destabilization procedures significantly increased motion. The addition of TCs did not significantly change motion in flexion and extension. Lateral bending was significantly decreased with 2 connectors, but not with 1 connector. The greatest effect was on axial rotation. In general, 2 TCs were more restrictive than 1 TC, and decreased motion 10% more than fixation alone. Conclusions. Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.

KW - Biomechanics

KW - Cervical spine fusion

KW - Lateral mass fixation

KW - Transverse connector

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