title: A biomechanical comparison of facet screw fixation and pedicle screw fixation: effects of short-term and long-term repetitive cycling.
abstract: METHODS
  A biomechanical study was conducted to assess the stabilization performance of transfacet pedicle screw fixation.
  
  
  OBJECTIVE
  To compare the biomechanical effects of short-term and long-term cyclic loading on lumbar motion segments instrumented with either a pedicle screw or a transfacet pedicle screw construct.
  
  
  BACKGROUND
  Facet screw fixation is an alternative to pedicle screw fixation that permits the use of a minimally invasive strategy. It is not known whether facet screw fixation can provide stability equivalent to pedicle screw fixation during cyclical loading. Therefore, transfacet pedicle screw fixation and standard pedicle screw fixation techniques were compared biomechanically.
  
  
  METHODS
  Lumbar motion segments were tested under short-term and long-term cyclic loading conditions. For the short-term phase, specimens were tested intact for six cycles (to 400 N or 4 Nm) in compression, flexion, extension, lateral bending, and torsion. The specimens then were instrumented with bilateral semicircular interbody spacers and pedicle screw instrumentation or transfacet pedicle screws, and the testing sequence was repeated. For the long-term phase, 12 specimens were instrumented in a similar manner and loaded to 6 Nm of flexion bending for 180,000 cycles.
  
  
  RESULTS
  For the short-term phase, both fixation systems had significantly greater stiffness and reduced range of motion, as compared with the intact state. No differences were observed between the fixation systems except in flexion, wherein transfacet pedicle screw specimens were significantly stiffer than traditional pedicle screw specimens. For the long-term phase, the stiffness and range of motion did not significantly increase or decrease over repetitive cycling of the instrumented specimens. Furthermore, no significant difference between the fixation systems was observed.
  
  
  CONCLUSIONS
  The stability provided by both transfacet pedicle screw fixation and traditional pedicle screw fixation was not compromised after repetitive cycling. In this model, transfacet pedicle screw fixation appears equivalent biomechanically to traditional pedicle screw fixation.
authors.affiliation: Cleveland Clinic Foundation, Spine Research Laboratory, Cleveland, Ohio 44195, USA. tobinm@ccf.org
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Ferrara
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Secor
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Jin
authors.forename: Andrew
authors.initials: A
authors.lastname: Wakefield
authors.forename: Serkan
authors.initials: S
authors.lastname: Inceoglu
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
mesh_terms: D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D015519:Bone Density; D001863:Bone Screws; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery*; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D009985:Orthopedics / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D013314:Stress, Mechanical
chemical_list: D001672:Biocompatible Materials