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The Effect of Partial Facetectomy Vs. No Facetectomy on Vertebral Purchase of Colorado-2 Pedicle Hook

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The Effect of Partial Facetectomy Vs. No Facetectomy on Vertebral Purchase of Colorado-2 Pedicle Hook The Journal of Turkish Spinal Surgery 2005; 16 (1): 1-89 KONGRE ÖZETLER‹ / ABSTRACTS THE EFFECT OF PARTIAL FACETECTOMY VS. NO FACETECTOMY ON VERTEBRAL PURCHASE OF COLORADO-2 PEDICLE HOOK NAZ‹R C‹HANG‹R ‹SLAM (Haydarpaßa Numune Hospital, Turkey), THOMAS STEFFEN, ENSORE TRANSFELDT, JAMES D SCHWENDER, LARA COHEN INTRODUCTION: Partial facetectomy can RESULTS: All of the no facetectomy cases improve the seating of the hook on the pedic- (100%) showed gap between pedicle and the le by different ways. The recommended pedic- hook and medialization in the x-rays. Half le hook placement in Colorado-2 system is (%50) of the facetectomy cases showed ideal without facetectomy. There is no biomechani- seating while the others (%50) showed some cal study in the literature comparing the medialization or gap. The failure forces and fa- strength of hook/laminar interface between the ilure patterns of no facetectomy (609N) and partial facetectomy an~ no facetectomy in the facetectomy (636N) groups were quite similar. Colorado-2 pedicle hook (C2PH) design aga- But a trend of difference appeared when the inst 45 degrees posterolateral pull-out force. ideally seated facetectomy group (778N) com- pared with the other cases (493N) of this gro- MATERIAL&METHODS: T4, T5, T8 and up (p<0.1). T9 levels of 5 fresh frozen human cadavers were instrumented with C2PH. Half of the imp- CONCLUSION: Facetectomy can reduce lant sites were undergone to facetectomy. the strength of the lamina in cases which the, hook does not seat ideally. This effect pro- The potted specimens, embedded in U bably due to destruction of the integrity of the shaped metal profile filled by PMMA, were lamina and facetectomy can become a risky mounted with a 45 degrees of angle to the lo- procedure if the hook misses the pedicle. But wer platform of MTS Mini Bionix Model Machi- facetectomy can facilitate the ideal seat of the ne and a pull-out force 45 degrees posterola- pedicle hook onto the pedicle in Colorado-2 teral to the specimen was applied by the upper pedicular hooks and contribute more strength arm of the MTS machine. The lower platform even without using any additional tools. was blocked and the upper arm permitted only for hinge movement between the rod and inst- rument during the posterolateral pull-outs. 1 Türk Omurga Cerrahisi Dergisi ORAL PRESENTATION COMPARISON OF VERTEBRAL PURCHASE STRENGTH FOR SEGMENTAL TRANSLATION OF PEDICLE SEREWS, SUBLAMINAR WIRES, PEDICLE HOOKS AND MODIFIED PEDICLE HOOKS NAZ‹R C‹HANG‹R ‹SLAM (Haydarpaßa Numune Hospital, Turkey), ENSOR E TRANSFELDT, THOMAS STEFFEN, D. SCHWENDER, LARA COHEN INTRODUCTION: Anchoring of pedicle unconstrained but permitted only for hinge hooks to the lamina provides improved movement in the constrained part of the study. stability and increased pull-out strength. RESULTS: LDCs of CPH and CPHS Studies compared anchored pedicle hooks to showed similar characteristics as observed in standard pedicle hooks as well as pedicle CPS and USSPH. Differences in failure forces screws against posteriorly directed pull-out among CPHS (430+/-118), USSPH (603+/- force. However, scoliosis correction creates a 328), and CPS (592+/-293) were insignificant, posterolateral resultant force. The goal of this however, LSLW (788+/-290) and CPH (175+/- study was to perform mechanical testing 93) were significantly different from others in simulating the posterolateral force created unconstrained part of the study. In the with the translational correction of scoliosis. constrained part, no difference was observed METHODS: After the measurement of BM between CPHS (442+/-164) and USSPH D, 26 fresh frozen human cadavers were (560+/-213). Only CPH (288+/-189) increased instrumented with Colorado Pedicle Hook its strength. (CPH), CPH-Staple (CPHS), USS-Pedicle CONCLUSION: The LDCs of CPH and Hook (USSPH), Colorado Pedicle Screw CPHS show that the latter keeps its hook (CPS), and Luque Sub-Laminar Wire (LSLW) properties but increases its strength with in the unconstrained but only the hooks were addition of the staple. Behavior of USSPH used in the constrained study. Pull-outs were resembles CPS. While CPHS and USSPH performed in 45° posterolateraly with MTS were showing significantly higher strength Mini Bionix Model Machine. The lower than CPH, especially during the unconstrained platform was free in all movements in pull-outs, they also kept their strength in horizontal plane in unconstrained but blocked constrained system. CPH and CPHS never in constrained part of the study. The upper violated the neural structures. arm restricted only rotation in the 2 The Journal of Turkish Spinal Surgery ORAL PRESENTATION RISK OF ADJACENT VERTEBRAL BODY FRACTURES AFTER BALLOON KYPHOPLASTY: A BIOMECHANICAL STUDY IOANNIS GAITANIS (Loyola University, Unidet States), CHRISTOPHER CRONSELL, MICHAEL VORONOV, EKATERINA KHMELNITSKAYA, ROBERT HAVEY, FRANK PHILLIPS, MICHAEL ZINDRICK, AVINASH PATWARDHAN INTRODUCTION: This biomechanical RESULTS: The initial VCF increased the study investigated the incidence, location, vertebral kyphosis (6.2°vs.18°, p<0.01). Ballo- morphology, and load required to create sub- on kyphoplasty significantly corrected the VB sequent VB fractures adjacent to balloon deformity; however, the residual kyphosis re- kyphoplasty. mained larger than the intact value (6.2°vs.11°, p<0.01). The adjacent VB fracture METHODS: Ten fresh human thoracolum- occurred above the initial VCF in six speci- bar specimens (9F/1 M), mean age 78±8.9yrs, mens, and below in four. The mean fracture each consisting ol 5 adjacent vertebrae were load was 698±328N. The BMD ol the adjacent used. BMD was measured. VB cortices were fractured VB was smailer than un-fractured VB instrumented with strain gauges. After cancel- (99.0 vs. 119 mg/cc, p<0.05). Macroscopic lous bone disruption in the middle VB, the spe- examination showed four specimens with cimens were compressed under follower load endplate depression and cortical wall fractu- until a fracture was observed with >25% ante- res, three with only endplate depression, and rior height loss. Fracture reduction was perfor- three with only cortical wall fractures. med by balloon kyphoplasty under a physiolo- gic preload of 250N. After bone cement harde- DISCUSSION: Fracture load for VB adja- ning the specimen was recompressed until an cent to kyphoplasty appears to be much smal- adjacent fracture was observed either on vi- ler compared with that reported for the first deo fluoroscopy or detected as discontinuity in VCF in osteoporotic spines. Low BMD was a the strain gauge data. The vertebral kyphosis strong risk factor lor location of subsequent after the initial fracture and after balloon fractures. The residual kyphosis and bone kyphoplasty, the location and morphology of cement augmentation may also contribute to the adjacent fracture, and fracture load were increased stress at adjacent levels, increasing recorded. the risk of subsequent fractures. 3 Türk Omurga Cerrahisi Dergisi ORAL PRESENTATION BIOMECHANICAL COMPARISON OF ANATOMIC TRAJECTORY VERSUS INJECTABLE CALCIUM SULFATE GRAFT AUGMENTED PEDICLE SCREW FOR SALVAGE IN CADAVERIC THORACIC BONE AL‹HAN DER‹NCEK (Twin Cities Spine Center, United States), CHUNHUI WU, AMIR MEHBOO, ENSOR TRANSFELDT INTRODUCTION: There are many ways to replaced either by calcium sulfate graft aug- salvage pedicle screws such as using larger mentation or anatomic trajectory lor salvage. and/or longer size pedicle screws, augmenta- The graft augmented screws were placed uti- tion or inserting screws in a different trajec- lizing the previous holes. Finally, MIT and tory. Although polymethylmethacrylate imme- POS ol the revision screws were recorded. diately increases the construct stiffness, it may RESULTS: The mean MIT decreased with cause bone necrosis, toxin relaxation and/or the anatomic trajectory salvage technique neural injury. On the other hand, calcium sul- when compared to the straight lorward appro- fate bone grafts have a high potential for biolo- ach, 0.23 Nm vs 0.38 Nm, respectively gic incorporation and no thermal damage effe- (p=0.003). The anatomic trajectory revision re- at. The anatomic trajectory technique can use sulted in decreased POS when compared lo both primary and revision procedures. The ob- the POS ol the straight forward, 297 N vs 469 ject of this study is to compare the biomecha- N, respectively (p=0.003). The graft augmen- nical periormance of the two pedicle screw re- tation increased the POS when compared to vision techniques in order to assist in clinical the POS of the straight forward, 680 N vs 477 decision making. N, respectively (p=0.017). The mean POS ra- MATERIAL AND METHODS: Polyaxial pe- tio of revised screw to original was 0.71 for dicle screws were lirst inserted with a straight anatomic trajectory screws and 1.8 for graft forward approach on both sides ol 17 fresh hu- augmented screws (p=0.002). man cadaveric thoracic vertebrae. The maxi- CONCLUSION: This study demonstrated mal insertion torque (MIT) for each screw was that graft augmented pedicle screw achieved measured and then axial pull-out strength belter POS than the anatomic trajectory tech- (POS) were recorded. Afterwards, these pe- nique in cadaveric thoracic spine. dicle screws were randomly assigned to be 4 The Journal of Turkish Spinal Surgery ORAL PRESENTATION METOPROLOL TREATMENT DECREASES TISSUE MYELOPEROXIDASE ACTIVITY AFTER SPINAL CORD INJURY IN RATS H. BER‹L GÖK (Ankara Atatürk Research Hospital, Turkey), ‹HSAN SOLAROÚLU, ÖZERK OKUTAN, BEHZAT Ç‹MEN, ERKAN KAPTANOÚLU, SELÇUK PALAOÚLU
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