Pedicle screws have dramatically improved the outcomes of spinal reconstruction requiring spinal fusion. Short-segment surgical treatments based on the use of pedicle screws for the treatment of neoplastic, developmental, congenital, traumatic, and degenerative conditions have been proved to be practical, safe, and effective. The Funnel Technique provides a straightforward, direct, and inexpensive way to very safely apply pedicle screws in the cervical, thoracic, or lumbar spine. Carefully applied pedicle-screw fixation does not produce severe or frequent complications. Pedicle-screw fixation can be effectively and safely used wherever a vertebral pedicle can accommodate a pedicle screw--that is, in the cervical, thoracic, or lumbar spine. Training in pedicle-screw application should be standard in orthopaedic training programs since pedicle-screw fixation represents the so-called gold standard of spinal internal fixation.

The use of pedicle-screw internal fixation for the operative treatment of spinal disorders.

Study Design. Multicenter prospective randomized trial. Objective. To test the hypotheses that thoracolumbar AO Type A spine fractures without neurologic deficit, managed with short-segment posterior stabilization will show an improved radiographic outcome and at least the same functional outcome as compared with nonsurgically treated thoracolumbar fractures. Summary of Background Data. There are various opinions regarding the ideal management of thoracolumbar Type A spine fractures without neurologic deficit. Both operative and nonsurgical approaches are advocated. Methods. Patients were randomized for operative or nonsurgical treatment. Data sampling involved demographics, fracture classifications, radiographic evaluation, and functional outcome. Results. Sixteen patients received nonsurgical therapy, and 18 received surgical treatment. Follow-up was completed for 32 (94%) of the patients after a mean of 4.3 years. At the end of follow-up, both local and regional kyphotic deformity was significantly less in the operatively treated group. All functional outcome scores (VAS Pain, VAS Spine Score, and RMDQ-24) showed significantly better results in the operative group. The percentage of patients returning to their original jobs was found to be significantly higher in the operative treated group. Conclusions. Patients with a Type A3 thoracolumbar spine fracture without neurologic deficit should be treated by short-segment posterior stabilization.

Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment.

To determine the effect of adding pedicle screws at the level of a burst fracture (intermediate screws) on the stiffness of a short segment pedicle fixation, an in vitro biomechanical study was carried out. Six fresh-frozen pig lumbar spine specimens were used. The flexibility of the intact specimen

Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures: a biomechanical study.

Object Three types of posterior thoracolumbar implants are in use today: pedicle screws, sublaminar titanium cables, and sublaminar hooks. The authors conducted a biomechanical comparison of these three implants in human cadaveric spines. Methods Spine specimens (T5–12) were harvested, radiographically assessed for fractures or metastases, and their bone mineral density (BMD) was measured. Individual vertebrae were disarticulated and fitted with either pedicle screws, sublaminar cables, or bilateral claw hooks. The longitudinal component of each construct consisted of bilateral 10-cm rods connected with two cross-connectors. The vertebral body was embedded in cement, and the rods were affixed to a ball-and-socket apparatus for the application of a distraction force. The authors analyzed 1) 20 vertebrae implanted with screws; 2) 20 with hooks, and 3) 20 with cables. The maximum pullout (MPO) forces prior to failure (mean ± standard deviation) for the screw, hook, and cable implants were 972 ± 330, 802 ± 35...

In vitro biomechanical comparison of pedicle screws, sublaminar hooks, and sublaminar cables

Study design This study evaluates the biomechanical characteristics of spinal instrumentation constructs in a human unstable thoracolumbar burst fracture model simulated by corpectomy. Objective To compare the biomechanical characteristics of short-segment posterior instrumentation, with and without crosslinks, in a human unstable burst fracture model simulated by corpectomy. Summary of background data Unstable thoracolumbar burst fractures are serious injuries, and their management remains controversial. Some authors advocate the use of short-segment posterior instrumentation for certain burst fractures. Whether crosslinks contribute additional stability has not been determined. Methods Six fresh frozen human spines (T10-L2) were potted to isolate the T11-L1 segments, and biomechanically tested in axial rotation, lateral bending, flexion, and extension. A custom spine testing system was used that allows motion with 6 degrees of freedom. After testing was completed on intact specimens, a corpectomy was performed at T12 to simulate an unstable burst fracture with loss of anterior and middle column support. Short-segment transpedicular instrumentation was then performed from T11 to L1. Each specimen was retested with 1, 2, or no crosslinks. Construct stiffness and motion data were analyzed with each intact specimen serving as its own internal control. Results Torsional stiffness in axial rotation was significantly increased (P 0.05). When attempting to load the constructs to failure, screw pullout was seen in all specimens. Conclusion Crosslinks, when added to short-segment posterior fixation, improve stiffness and decrease motion in axial rotation, but do not restore baseline stability in this corpectomy model. Short-segment posterior fixation is also inadequate in restoring stability in flexion with injuries of this severity. Short-segment posterior instrumentation alone can achieve baseline stability in lateral bending, and crosslinks provide even greater stiffness.

Biomechanical evaluation of short-segment posterior instrumentation with and without crosslinks in a human cadaveric unstable thoracolumbar burst fracture model.

Study design Pedicle screw fixation for unstable thoracolumbar spine injuries is relatively new. The effect of one or two crosslinks on rotational and lateral bending stiffness was studied. Objective To determine the rotational and bending stiffness values of thoracolumbar fractures fixed by the AO's internal fixation system with zero, one, or two crosslinks. Methods Eight embalmed thoracolumbar spine segments. (T12-L2) were instrumented at T12 and L2 with a pedicle screw-rod system. Rotational stiffness was determined for 10 cycles to 2.5 degrees, 3.5 degrees, and 5 degrees of rotation, with and without one or two crosslinks, and lateral bending stiffness for 10 cycles to 0.25, 0.40, and 0.50 inch. The results showed a clear trend toward increased stiffness with crosslinks. Results The stiffness values of the two-crosslink construct at 2.5 degrees and 3.5 degrees of rotation were significantly higher than those of the zero-crosslink system. Also, the bending stiffness of the two-crosslink construct was significantly higher than that of no-crosslink system at all of the displacements. Conclusions Rotational stiffness values of the two-crosslink construct were significantly higher than those of the zero-crosslink system, at 2.5 degrees and 3.5 degrees of rotation. Lateral bending stiffness of the two-crosslink system was higher than that of the zero-crosslink system at all levels of displacement.

Mechanical stability of thoracolumbar pedicle screw fixation. The effect of crosslinks.

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Mechanical stability of thoracolumbar pedicle screw fixation. The effect of crosslinks.