title: Novel pedicle screw and plate system provides superior stability in unilateral fixation for minimally invasive transforaminal lumbar interbody fusion: an in vitro biomechanical study.
abstract: OBJECTIVE
  This study aims to compare the biomechanical properties of the novel pedicle screw and plate system with the traditional rod system in asymmetrical posterior stabilization for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). We compared the immediate stabilizing effects of fusion segment and the strain distribution on the vertebral body.
  
  
  METHODS
  Seven fresh calf lumbar spines (L3-L6) were tested. Flexion/extension, lateral bending, and axial rotation were induced by pure moments of ± 5.0 Nm and the range of motion (ROM) was recorded. Strain gauges were instrumented at L4 and L5 vertebral body to record the strain distribution under flexion and lateral bending (LB). After intact kinematic analysis, a right sided TLIF was performed at L4-L5. Then each specimen was tested for the following constructs: unilateral pedicle screw and rod (UR); unilateral pedicle screw and plate (UP); UR and transfacet pedicle screw (TFS); UP and TFS; UP and UR.
  
  
  RESULTS
  All instrumented constructs significantly reduced ROM in all motion compared with the intact specimen, except the UR construct in axial rotation. Unilateral fixation (UR or UP) reduced ROM less compared with the bilateral fixation (UP/UR+TFS, UP+UR). The plate system resulted in more reduction in ROM compared with the rod system, especially in axial rotation. UP construct provided more stability in axial rotation compared with UR construct. The strain distribution on the left and right side of L4 vertebral body was significantly different from UR and UR+TFS construct under flexion motion. The strain distribution on L4 vertebral body was significantly influenced by different fixation constructs.
  
  
  CONCLUSIONS
  The novel plate could provide sufficient segmental stability in axial rotation. The UR construct exhibits weak stability and asymmetrical strain distribution in fusion segment, while the UP construct is a good alternative choice for unilateral posterior fixation of MI-TLIF.
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Jie
authors: J
authors: Li
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Hong
authors: H
authors: Xiao
authors: Department of Orthopaedic and Spinal Surgery, Nanfang Hospital Southern Medical University, Guangzhou, Guangdong, China.
authors: Qingan
authors: Q
authors: Zhu
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Yue
authors: Y
authors: Zhou
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Changqing
authors: C
authors: Li
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Huan
authors: H
authors: Liu
authors: Department of Orthopaedic and Spinal Surgery, Nanfang Hospital Southern Medical University, Guangzhou, Guangdong, China.
authors: Zhiping
authors: Z
authors: Huang
authors: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors: Jin
authors: J
authors: Shang
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001860:Bone Plates; D002417:Cattle; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D065289:Pedicle Screws; D016059:Range of Motion, Articular; D012399:Rotation; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*