Ultra–high-molecular-weight polyethylene sublaminar tape as semirigid fixation or pedicle screw augmentation to prevent failure in long-segment spine surgery: an ex vivo biomechanical study

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  • 1 Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands;
  • 2 Centre of Research in Mechanical Engineering—CIIM, Department of Mechanical Engineering and Materials, Universitat Politècnica de València, Spain;
  • 3 Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven; and
  • 4 Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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OBJECTIVE

Complications after adult spinal deformity surgery are common, with implant-related complications occurring in up to 27.8% of cases. Sublaminar wire fixation strength is less affected by decreasing trabecular bone density in comparison to pedicle screw (PS) fixation due to the predominant cortical bone composition of the lamina. Sublaminar fixation may thus aid in decreasing implant-related complications. The goal of this study was to compare fixation characteristics of titanium sublaminar cables (SCs), ultra–high-molecular-weight polyethylene (UHMWPE) tape, PSs, and PSs augmented with UHMWPE tape in an ex vivo flexion–bending setup.

METHODS

Thirty-six human cadaver vertebrae were stratified into 4 different fixation groups: UHMWPE sublaminar tape (ST), PS, metal SC, and PS augmented with ST (PS + ST). Individual vertebrae were embedded in resin, and a flexion–bending moment was applied that closely resembles the in vivo loading pattern at transitional levels of spinal instrumentation.

RESULTS

The failure strength of PS + ST (4522 ± 2314 N) was significantly higher compared to the SC (2931 ± 751 N) and PS (2678 ± 827 N) groups, which had p values of 0.028 and 0.015, respectively (all values expressed as the mean ± SD). Construct stiffness was significantly higher for the PS groups compared to the stand-alone sublaminar wiring groups (p = 0.020). In contrast to SC, ST did not show any case of cortical breach.

CONCLUSIONS

The higher failure strength of PS + ST compared to PS indicates that PS augmentation with ST may be an effective measure to reduce the incidence of screw pullout, even in osteoporotic vertebrae. Moreover, the lower stiffness of sublaminar fixation techniques and the absence of damage to the cortices in the ST group suggest that ST as a stand-alone fixation technique in adult spinal deformity surgery may also be clinically feasible and offer clinical benefits.

ABBREVIATIONS ASD = adult spinal deformity; BMD = bone mineral density; FE = finite element; PS = pedicle screw; SC = sublaminar cable; ST = sublaminar tape; UHMWPE = ultra–high-molecular-weight polyethylene.

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Contributor Notes

Correspondence Remco Doodkorte: Maastricht University, Maastricht, The Netherlands. rjp.doodkorte@maastrichtuniversity.nl.

INCLUDE WHEN CITING Published online October 30, 2020; DOI: 10.3171/2020.6.SPINE20605.

Disclosures Dr. Arts receives clinical or research support for the study described (includes equipment or materials) from DSM Biomedical. Mr. van Rietbergen is a consultant for Scanco Medical AG.

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