title: Biomechanical evaluation of a novel posterior integrated clamp that attaches to an existing posterior instrumentation for use in thoracolumbar revision.
abstract: METHODS
  An in vitro biomechanical study.
  
  
  OBJECTIVE
  To evaluate the biomechanics of a novel posterior integrated clamp (IC) that extends on an already implanted construct in comparison to single long continuous bilateral pedicle screw (BPS) and rod stabilization system.
  
  
  BACKGROUND
  Revision surgery in the thoracolumbar spine often necessitates further instrumentation following a failed previous back surgery. Stability of these reconstructed constructs is not known.
  
  
  METHODS
  Six osteoligamentous T12-L5 calf spines were tested on a spine motion simulator in the following configurations: intact, four level constructs (T13-L4), three level constructs (L1-L4), and two level constructs (L2-L4), by varying the ratio between BPS and IC. A load control protocol of 8 Nm moments was applied at a rate of 1°/sec to establish the range of motion value for each construct in flexion-extension, lateral bending, and axial rotation. Statistical analysis was performed on raw data using repeated measures analysis of variance and significance was set at p<0.05.
  
  
  RESULTS
  On an average, the reduction in motion for the four level continuous pedicle screw and rod construct (67%) was similar to those extended with integrated clamps (64%). Furthermore, for three level and two level constructs, no significant difference was observed between continuous pedicle screw constructs and those revised with the integrated clamps (regardless of the ratio between BPS and IC).
  
  
  CONCLUSIONS
  The novel posterior IC showed equivalent biomechanical rigidity to continuous pedicle screw rod constructs in revision scenarios. Clinical studies on posterior rod adjunct systems are necessary to confirm these results.
authors.affiliation: University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Senatus
authors.forename: Suresh Reddy
authors.initials: SR
authors.lastname: Chinthakunta
authors.forename: Pedram
authors.initials: P
authors.lastname: Vazifeh
authors.forename: Saif
authors.initials: S
authors.lastname: Khalil
keywords: Bone screws; Clamp; Internal fixation; Surgical revision; Thoracic