Spine · 1994
The effects of implant stiffness on the bypassed bone mineral density and facet fusion stiffness of the canine spine.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Craven T G, Carson W L, Asher M A, Robinson R G
Аннотация
STUDY DESIGN: Effects of spinal implant stiffness and removal/retention on bypassed bone mineral density and column/fusion stiffness were studied in dogs.
METHODS: After facet fusion and bicortical peripedicle screw placement, one group of eight dogs received 6.35 mm and another 4.76 mm rod instrumentation at L3-L5. At 12 weeks, four in each group had implants removed. Bone mineral density was analyzed by dual energy x-ray absorptiometry at 1 to 24 weeks. Axial compressive stiffness of the L3-L5 construct, spinal column, fused facets, and instrumentation were measured. Percent load through the vertebral column was predicted.
RESULTS: Five observations were made for this canine model. First, stiffer implants resulted in more bypassed bone mineral loss at 6 and 12 weeks, plateauing and not different at 24 weeks. Second, after implant removal, a significant and similar rebound in bone mineral density occurred. Third, 4.76 mm rod instrumentation (initially 71% load through column) resulted in stiffer posterior fusions and vertebral columns than 6.35 mm rod instrumentation (initially 57% load through column). Fourth, marked stiffening of the anterior-middle columns (apparently disks) occurred. Fifth, percent load borne by the vertebral column increased with time.
CONCLUSIONS: There appears to be a range of percent load through the vertebral column that creates optimum fusion/column stiffening while limiting bone stress shielding effects. The 6.35 mm rod constructs were predicted to allow greater than 70% axial load through the adult human thoracic/lumbar spine, implying biologic responses similar to 4.76 mm rods in dogs.
METHODS: After facet fusion and bicortical peripedicle screw placement, one group of eight dogs received 6.35 mm and another 4.76 mm rod instrumentation at L3-L5. At 12 weeks, four in each group had implants removed. Bone mineral density was analyzed by dual energy x-ray absorptiometry at 1 to 24 weeks. Axial compressive stiffness of the L3-L5 construct, spinal column, fused facets, and instrumentation were measured. Percent load through the vertebral column was predicted.
RESULTS: Five observations were made for this canine model. First, stiffer implants resulted in more bypassed bone mineral loss at 6 and 12 weeks, plateauing and not different at 24 weeks. Second, after implant removal, a significant and similar rebound in bone mineral density occurred. Third, 4.76 mm rod instrumentation (initially 71% load through column) resulted in stiffer posterior fusions and vertebral columns than 6.35 mm rod instrumentation (initially 57% load through column). Fourth, marked stiffening of the anterior-middle columns (apparently disks) occurred. Fifth, percent load borne by the vertebral column increased with time.
CONCLUSIONS: There appears to be a range of percent load through the vertebral column that creates optimum fusion/column stiffening while limiting bone stress shielding effects. The 6.35 mm rod constructs were predicted to allow greater than 70% axial load through the adult human thoracic/lumbar spine, implying biologic responses similar to 4.76 mm rods in dogs.