title: Biomechanical comparison of a novel percutaneous transfacet device and a traditional posterior system for single level fusion.
abstract: Posterior spinal fusions are indicated for a variety of spinal disorders. Transfacet fixation minimizes soft tissue disruption and preserves the adjacent facet joint. This technique is uncommon due to concerns with biomechanical stability and proper implant placement. For these reasons, a length adjustable implant may obviate the clinical concerns but necessitates biomechanical study. This study evaluated the in vitro biomechanical stability between a novel transfacet fixation device compared with standard pedicle screws during cyclic physiologic loading in a human cadaveric model. Cadaveric L4-L5 lumbar motion segments from 16 human spines were tested in cyclic flexion/extension, lateral bending, and torsion after insertion of either transfacet fixation devices or 5.5 mm pedicle screw instrumentation. A load cell was used to measure the compressive forces on the anterior column during testing. Motion segment stiffness and anterior column compression were analyzed with a 1-way analysis of variance (P<0.05). The transfacet device demonstrated a statistically similar stiffness when compared with the pedicle screw system for each test direction. For anterior column loading during physiologic testing, there were no biomechanical differences between stabilization systems. Percutaneous transfacet fixation is an attractive surgical option for single-level spinal fusions. A biomechanical evaluation of a novel device for this application demonstrated similar stability to a pedicle screw system. The length adjustability of the device may alleviate concerns for precise device placement and the biomechanical stability may produce similar rates and quality of posterior spinal fusions.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego, CA, USA. amahar@chsd.org
authors.forename: Andrew
authors.initials: A
authors.lastname: Mahar
authors.forename: Choll
authors.initials: C
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Oka
authors.forename: Tim
authors.initials: T
authors.lastname: Odell
authors.forename: Andrew
authors.initials: A
authors.lastname: Perry
authors.forename: Srdjan
authors.initials: S
authors.lastname: Mirkovic
authors.forename: Steve
authors.initials: S
authors.lastname: Garfin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002102:Cadaver; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018583:Pliability; D013123:Spinal Fusion / Q000295:instrumentation*; D016474:Weight-Bearing; D021801:Zygapophyseal Joint / Q000601:surgery*