Biomechanical Evaluation of a Dynamic Stabilization System for the Prevention of Proximal Junctional Failure in Adult Deformity Surgery

摘要

Study Design. Biomechanical spine model. Comparison of stress in the implant and the adjacent cranial segment was done with conventional rigid versus dynamic stabilization system (DS) fixation. Objective. The aim of this study was to study stress at the proximal end of spinal fixation with a novel DS. Summary of Background Data. High stress at the implant bone junction may cause proximal junctional failure (PJF) in adult deformity surgery. Methods. Five life-size spine models were instrumented with pedicle screws and a 5.5-mm Titanium rod from T8-S1. The same models were subsequently instrumented with a similar rod and DS between T8-9 pedicle screws. The spine model was loaded with 25 Nm static load cranial to the proximal fixation in six directions. Strains were measured from the proximal screws. Disc pressure was measured from the proximal instrumented segment (T8-9) and cranial adjacent segment (T7-8). Results. Rigid fixation produced highest strain at T8, followed by T10 then T9. In contrast, DS fixation produced highest strain at T10, followed by T9 then T8. Strain at T8 was significantly less with DS fixation than rigid fixation (P = 0.019). The T10 screw strain was not significantly higher with DS stabilization compared to rigid fixation (P = 0.091). Rigid fixation allowed no load-sharing or pressure rise at T8-9 but an abrupt rise at T7-8. DS system permitted load-sharing and pressure rise in T8-9; the difference compared to rigid fixation was significant in flexion loading (P = 0.04) and similar trend but not significant in extension (P = 0.09). DS system produced a rise in the adjacent segment disc pressure (T7-8), which was smaller than rigid fixation but not significant. Conclusion. Long spinal fixation using rigid rods produces maximum stress at the proximal end screw and increases adjacent disc pressure, possibly leading to PJF. Dynamic stabilization at the cranial end segment may prevent PJF by reducing these factors.