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Biomechanics of Lumbar Cortical Screw–Rod Fixation Versus Pedicle Screw–Rod Fixation With and Without Interbody Support

Perez-Orribo, Luis MD*; Kalb, Samuel MD; Reyes, Phillip M. BSE*; Chang, Steve W. MD†,*; Crawford, Neil R. PhD*

doi: 10.1097/BRS.0b013e318279a95e

Study Design. Seven different combinations of posterior screw fixation, with or without interbody support, were compared in vitro using nondestructive flexibility tests.

Objective. To study the biomechanical behavior of a new cortical screw (CS) fixation construct relative to the traditional pedicle screw (PS) construct.

Summary of Background Data. The CS is an alternative to the PS for posterior fixation of the lumbar spine. The CS trajectory is more sagittally and cranially oriented than the PS, being anchored in the pars interarticularis. Like PS fixation, CS fixation uses interconnecting rods fastened with top-locking connectors. Stability after bilateral CS fixation was compared with stability after bilateral PS fixation in the setting of intact disc and with direct lateral interbody fixation (DLIF) or transforaminal lateral interbody fixation (TLIF) support.

Methods. Standard nondestructive flexibility tests were performed in cadaveric lumbar specimens, allowing non-paired comparisons of specific conditions from 28 specimens (4 groups of 7) within a larger experiment of multiple hardware configurations. Condition tested and group from which results originated were as follows: (1) intact (all groups); (2) with L3–L4 bilateral PS-rods (group 1); (3) with bilateral CS-rods (group 2); (4) with DLIF (group 3); (5) with DLIF + CS-rods (group 4); (6) with DLIF + PS-rods (group 3); (7) with TLIF + CS-rods (group 2), and (8) with TLIF + PS-rods (group 2). To assess spinal stability, the mean range of motion, lax zone, and stiff zone at L3–L4 were compared during flexion-extension, lateral bending, and axial rotation.

Results. With intact disc, stability was equivalent after PS-rod and CS-rod fixation, except that PS-rod fixation was stiffer during axial rotation. With DLIF support, there was no significant difference in stability between PS-rod and CS-rod fixation. With TLIF support, PS-rod fixation was stiffer than CS-rod fixation during lateral bending.

Conclusion. Bilateral CS-rod fixation provided about the same stability in cadaveric specimens as PS-rod fixation regardless of the presence of interbody, TLIF, or DLIF support.

Cortical screws (CS) represent an alternative to pedicle screws (PS) for lumbar posterior fixation. We compared biomechanically single-level CS and PS constructs using interlocking rods, with intact disc and with transforaminal lateral interbody fixation or direct lateral interbody fixation implants. CS provided equivalent stability to PS in vitro.

*Spinal Biomechanics Laboratory, Department of Neurosurgery Research; and

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.

Address correspondence and reprint requests to Neil R. Crawford, PhD, C/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013; E-mail:

Acknowledgment date: May 15, 2012. First revision date: August 31, 2012. Acceptance date: October 9, 2012.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Medtronic research grant funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy, stock/stock options.

© 2013 Lippincott Williams & Wilkins, Inc.