The Influence of Fixation Rigidity on Intervertebral Joints - An Experimental Comparison between a Rigid and a Flexible System.

Kim, Won Joong; Lee, Sang Ho; Shin, Song Woo; Rivard, Charles H; Coillard, Christine; Rhalmi, Souad

Original Article

Journal of Korean Neurosurgical Society 2005;37(5): 364-369.

Won Joong Kim, Sang Ho Lee, Song Woo Shin, Charles H Rivard, Christine Coillard, Souad Rhalmi

¹Department of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Korea. frangiewjk@hotmail.com
²Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
³Department of Neurosurgery, Research Center, St. Justine Hospital, Montreal, Canada.

ABSTRACT

OBJECTIVE
Spinal instrumentation without fusion often fails due to biological failure of intervertebral joints (spontaneous fusion, degeneration, etc). The purpose of this study is to investigate the influence of fixation rigidity on viability of intervertebral joints. METHODS: Twenty pigs in growing period were subjected to posterior segmental fixation. Twelve were fixed with a rigid fixation system(RF) while eight were fixed with a flexible unconstrained implant(FF). At the time of the surgery, a scoliosis was created to monitor fixation adequacy. The pigs were subjected to periodic radiological examinations and 12pigs (six in RF, six in FF) were euthanized at 12-18months postoperatively for analysis. RESULTS: The initial scoliotic curve was reduced from 31+/-5degrees to 27+/-8degrees in RF group (p=0.37) and from 19+/-4degrees to 17+/-5degrees in FF group (p=0.21). Although severe disc degeneration and spontaneous fusion of facet joints were observed in RF group, disc heights of FF group were well maintained without major signs of degeneration. CONCLUSION: The viability of the intervertebral joints depends on motion spinal fixation. Systems allowing intervertebral micromotion may preserve the viability of intervertebral discs and the facet joint articular cartilages while maintaining a reasonably stable fixation.

Key Words: Intervertebral joint viability; Spinal instrumentation; Fixation rigidity