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4. The Effects of Unitizing Nail-Plate Constructs in Distal Femur Fractures: A Biomechanical Study

Author

Mayer, Erik, primary, Lendhey, Matin, additional, Kelley, Benjamin, additional, Shi, Brendan, additional, Upfill-Brown, Alexander, additional, Devana, Sai K., additional, Brodke, Dane, additional, Shah, Akash, additional, Sekimura, Troy, additional, Gudapati, Varun, additional, Zukotynski, Brian, additional, Park, Jeannie, additional, Witt, Amber R., additional, Marciante, Mara, additional, Mahoney, Jonathan M., additional, Bucklen, Brandon S., additional, and Lee, Christopher, additional

Published
2024
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7. A Dual-Screw Technique for Vertebral Compression Fractures via Robotic Navigation in the Osteopenic Lumbar Spine: An In-Vitro Biomechanical Analysis.

Author

Steinmetz, Michael P., Riggleman, Jessica R., Mahoney, Jonathan M., Harris, Jonathan A., Butler, John B., Ferrick, Bryan J., and Bucklen, Brandon S.

Subjects
VERTEBRAL fractures, LUMBAR vertebrae, ULTIMATE strength, ROBOTICS
Abstract

Study Design: Biomechanical cadaveric study. Objectives: Multi-rod constructs maximize posterior fixation, but most use a single pedicle screw (PS) anchor point to support multiple rods. Robotic navigation allows for insertion of PS and cortical screw (CS) within the same pedicle, providing 4 points of bony fixation per vertebra. Recent studies demonstrated radiographic feasibility for dual-screw constructs for posterior lumbar spinal fixation; however, biomechanical characterization of this technique is lacking. Methods: Fourteen cadaveric lumbar specimens (L1–L5) were divided into 2 groups (n = 7): PS, and PS + CS. VCF was simulated at L3. Bilateral posterior screws were placed from L2–L4. Load control (±7.5Nm) testing performed in flexion-extension (FE), lateral bending (LB), axial rotation (AR) to measure ROM of: (1) intact; (2) 2-rod construct; (3) 4-rod construct. Static compression testing of 4-rod construct performed at 5 mm/min to measure failure load, axial stiffness. Results: Four-rod construct was more rigid than 2-rod in FE (P <.001), LB (P <.001), AR (P <.001). Screw technique had no significant effect on FE (P =.516), LB (P =.477), or AR (P =.452). PS + CS 4-rod construct was significantly more stable than PS group (P =.032). Stiffness of PS + CS group (445.8 ± 79.3 N/mm) was significantly greater (P =.019) than PS (317.8 ± 79.8 N/mm). Similarly, failure load of PS + CS group (1824.9 ± 352.2 N) was significantly greater (P =.001) than PS (913.4 ± 309.8 N). Conclusions: Dual-screw, 4-rod construct may be more stable than traditional rod-to-rod connectors, especially in axial rotation. Axial stiffness and ultimate strength of 4-rod, dual-screw construct were significantly greater than rod-to-rod. In this study, 4-rod construct was found to have potential biomechanical benefits of increased strength, stiffness, stability. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Robotic-Assisted Navigation for Stereotactic Neurosurgery: A Cadaveric Investigation of Accuracy, Time, and Radiation

Author

Anderson, William, primary, Ponce, Francisco A., additional, Kinsman, Michael J., additional, Sani, Sepehr, additional, Hwang, Brian, additional, Ghinda, Diana, additional, Kogan, Michael, additional, Mahoney, Jonathan M., additional, Amin, Dhara B., additional, Van Horn, Margaret, additional, McGuckin, Joshua P., additional, Razo-Castaneda, Dominic, additional, and Bucklen, Brandon S., additional

Published
2023
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13. A Dual-Screw Technique for Vertebral Compression Fractures via Robotic Navigation in the Osteopenic Lumbar Spine: An In-VitroBiomechanical Analysis

Author

Steinmetz, Michael P., Riggleman, Jessica R., Mahoney, Jonathan M., Harris, Jonathan A., Butler, John B., Ferrick, Bryan J., and Bucklen, Brandon S.

Abstract

Study Design Biomechanical cadaveric study.Objectives Multi-rod constructs maximize posterior fixation, but most use a single pedicle screw (PS) anchor point to support multiple rods. Robotic navigation allows for insertion of PS and cortical screw (CS) within the same pedicle, providing 4 points of bony fixation per vertebra. Recent studies demonstrated radiographic feasibility for dual-screw constructs for posterior lumbar spinal fixation; however, biomechanical characterization of this technique is lacking.Methods Fourteen cadaveric lumbar specimens (L1–L5) were divided into 2 groups (n = 7): PS, and PS + CS. VCF was simulated at L3. Bilateral posterior screws were placed from L2–L4. Load control (±7.5Nm) testing performed in flexion-extension (FE), lateral bending (LB), axial rotation (AR) to measure ROM of: (1) intact; (2) 2-rod construct; (3) 4-rod construct. Static compression testing of 4-rod construct performed at 5 mm/min to measure failure load, axial stiffness.Results Four-rod construct was more rigid than 2-rod in FE (P< .001), LB (P< .001), AR (P< .001). Screw technique had no significant effect on FE (P= .516), LB (P= .477), or AR (P= .452). PS + CS 4-rod construct was significantly more stable than PS group (P= .032). Stiffness of PS + CS group (445.8 ± 79.3 N/mm) was significantly greater (P= .019) than PS (317.8 ± 79.8 N/mm). Similarly, failure load of PS + CS group (1824.9 ± 352.2 N) was significantly greater (P= .001) than PS (913.4 ± 309.8 N).Conclusions Dual-screw, 4-rod construct may be more stable than traditional rod-to-rod connectors, especially in axial rotation. Axial stiffness and ultimate strength of 4-rod, dual-screw construct were significantly greater than rod-to-rod. In this study, 4-rod construct was found to have potential biomechanical benefits of increased strength, stiffness, stability.

Published
2024
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14. Comprehensive Evaluation of Accessory Rod Position, Rod Material and Diameter, Use of Cross-connectors, and Anterior Column Support in a Pedicle Subtraction Osteotomy Model: Part I: Effects on Apical Rod Strain: An In Vitro and In Silico Biomechanical Study

Author

Gelb, Daniel E., Tareen, Jarid, Jazini, Ehsan, Ludwig, Steven C., Harris, Jonathan A., Amin, Dhara B., Wang, Wenhai, Van Horn, Margaret R., Patel, Pavan D., Mirabile, Belin A., and Bucklen, Brandon S.

Published
2021
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20. Selecting the lowest instrumented vertebra in a multilevel posterior cervical fusion across the cervicothoracic junction: a biomechanical investigation

Author

Gelfand, Yaroslav, primary, Franco, Daniel, additional, Kinon, Merritt D., additional, De la Garza Ramos, Rafael, additional, Yassari, Reza, additional, Harris, Jonathan A., additional, Flamand, Samantha, additional, McGuckin, Joshua P., additional, Gonzalez, Jorge L., additional, Mahoney, Jonathan M., additional, and Bucklen, Brandon S., additional

Published
2023
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31. An In Vitro Biomechanical Analysis of Contralateral Sacroiliac Joint Motion Following Unilateral Sacroiliac Stabilization with and without Lumbosacral Fixation.

Author

Woojin Cho, Wenhai Wang, Hyun Jin Lim, and Bucklen, Brandon S.

Subjects
SACROILIAC joint, MOTION capture (Human mechanics), RANGE of motion of joints, BENDING moment, LIGAMENTS
Abstract

Study Design: Cadaveric biomechanics study. Purpose: This study investigated the effects of unilateral sacroiliac joint (SIJ) fixation for fusion with/without L5-S1 fixation on contralateral SIJ range of motion (ROM). Overview of Literature: SIJ fusion raises concerns that unilateral SIJ stabilization for fusion may increase contralateral SIJ mobility, leading to accelerated SIJ degeneration. Also, prior lumbosacral fixation may lead to accelerated SIJ degeneration, due to adjacent level effects. SIJ fixation biomechanics have been evaluated, showing a reduced-ROM, but SIJ fixation effects on contralateral nonfixated SIJ remain unknown. Methods: Seven human lumbopelvic spines were used, each affixed to six-degrees-of-freedom testing apparatus; 8.5-Nm pure unconstrained bending moments applied in flexion-extension, lateral bending, and axial rotation. The ROM of left and right SIJ was measured using a motion analysis system. Each specimen tested as (1) intact, (2) injury (left), (3) L5-S1 fixation, (4) unilateral stabilization (left), (5) unilateral stabilization+L5-S1 fixation, (6) bilateral stabilization, and (7) bilateral stabilization+L5-S1 fixation. Both left-sided iliosacral and posterior ligaments were cut for injury condition to model SIJ instability before surgery. Results: There were no statistical differences between fixated and contralateral nonfixated SIJ ROM following unilateral stabilization with/without L5-S1 fixation for all loading directions (p >0.930). Injured condition and L5-S1 fixation provided the largest motion increases across both joints; no significant differences were recorded between SIJs in any loading direction (p >0.850). Unilateral and bilateral stabilization with/without L5-S1 fixation reduced ROM compared with the injured condition for both SIJs, with bilateral stabilization providing maximum stability. Conclusions: In the cadaveric model, unilateral SIJ stabilization with/without lumbosacral fixation did not lead to significant contralateral SIJ hypermobility; long-term changes and in vivo response may differ. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Laterally Placed Expandable Interbody Spacers With and Without Adjustable Lordosis Improve Radiographic and Clinical Outcomes: A Two-Year Follow-Up Study

Author

Li, Yan M, Huang, Zheng, Towner, James, Li, Yan I, and Bucklen, Brandon S

Subjects
Orthopedics, expandable interbody spacers, adjustable lordosis, degenerative disc disease, General Engineering, mis llif, sagittal correction
Abstract

Introduction Interbody spacers are necessary for achieving disc height restoration when surgical intervention is used for the treatment of severe degenerative disc disease. Minimally invasive lateral lumbar interbody fusion (MIS LLIF) is a popular surgical approach that historically uses large static interbody spacers through a lateral approach. However, static spacers have been associated with iatrogenic distraction and excessive impaction forces, which may increase the risk of subsidence and loss of lordosis, compromising stability. Expandable interbody spacers with or without adjustable lordosis may help address these concerns by maximizing segmental lordosis and aiding in sagittal balance correction. This study describes the clinical and radiographic outcomes of patients treated with expandable interbody spacers with or without adjustable lordosis, for MIS LLIF. Materials and methods This is retrospective, single-surgeon Institutional Review Board-exempt chart review was of 103 consecutive patients who had undergone MIS LLIF at one to two contiguous level(s) utilizing expandable interbody spacers with or without adjustable lordosis (66/103 patients had adjustable lordosis spacers). Collection of clinical and radiographic functional outcomes occurred at preoperative and postoperative time points through 24 months. Results One-hundred and three consecutive patients were evaluated-average age, 58.2 ± 12.1 years; 42.1% (45/107) were female. There were 78.6% (81/103) one-level cases and 21.4% (22/103) two-level cases for a total of 125 levels; 44.8% (56/125) were performed at L4-5 and 34.4% (43/125) at L3-4. The average estimated blood loss was 24.6 ± 12.3cc. Mean operative time was 61.0 ± 19.1 min, and mean fluoroscopic time was 28.2 ± 14.6 sec. Visual Analog Scale (VAS) back and leg pain scores decreased significantly by an average of 7.1 ± 1.0 points at 24 months (p

Published
2021

33. Fixation Strength of Modified Iliac Screw Trajectory Compared to Traditional Iliac and S2 Alar-Iliac Trajectories: A Cadaveric Study

Author

Von Glinski, Alexander, primary, Pierre, Clifford, additional, Frieler, Sven, additional, Mahoney, Jonathan M., additional, Harris, Jonathan A., additional, Amin, Dhara B., additional, Allall, May, additional, Bucklen, Brandon S., additional, Schildhauer, Thomas A., additional, Oskouian, Rod J., additional, and Chapman, Jens R., additional

Published
2021
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38. Comprehensive Evaluation of Accessory Rod Position, Rod Material and Diameter, Use of Cross-connectors, and Anterior Column Support in a Pedicle Subtraction Osteotomy Model

Author

Gelb, Daniel E., primary, Tareen, Jarid, additional, Jazini, Ehsan, additional, Ludwig, Steven C., additional, Harris, Jonathan A., additional, Amin, Dhara B., additional, Wang, Wenhai, additional, Van Horn, Margaret R., additional, Patel, Pavan D., additional, Mirabile, Belin A., additional, and Bucklen, Brandon S., additional

Published
2020
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39. Comprehensive In Silico Evaluation of Accessory Rod Position, Rod Material and Diameter, Use of Cross-connectors, and Anterior Column Support in a Pedicle Subtraction Osteotomy Model

Author

Jazini, Ehsan, primary, Gelb, Daniel E., additional, Tareen, Jarid, additional, Ludwig, Steven C., additional, Harris, Jonathan A., additional, Amin, Dhara B., additional, Wang, Wenhai, additional, Van Horn, Margaret R., additional, Patel, Pavan D., additional, Mirabile, Belin A., additional, and Bucklen, Brandon S., additional

Published
2020
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43. A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size.

Author

Ilyas, Asif M., Mahoney, Jonathan M., and Bucklen, Brandon S.

Abstract

Background: There is evidence that interfragmentary fracture gap size may affect the compression achievable with a modern headless compression screw (HCS). This mechanical study compared the compression achieved by 3 commercial HCS systems through various fracture gaps: CAPTIVATE Headless (Globus Medical, Inc, Audubon, Pennsylvania), Synthes (DePuy Synthes, Westchester, Pennsylvania), and Acumed Acutrak 2 (Acumed LLC, Hillsboro, Oregon). Methods: Screws were inserted into a custom test fixture composed of polyurethane synthetic bone foam fragments, separated by a layer of easily compressible polyurethane foam simulating a fracture gap. Compression was measured after final insertion and countersinking. The effect of the interfragmentary fracture gap size on the compression generated was also investigated. Results: The CAPTIVATE Headless 3.0 mm screw (70.1 ± 5.7 N) and the Synthes 3.0 mm screw (64.9 ± 7.3 N) achieved similar compressive forces after final countersink. Similar comparisons were found for the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws, and the CAPTIVATE Headless 4.0 mm and Acutrak 2 Standard screws. The final compression of the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws was not significantly affected when the fracture gap was doubled from 2 to 4 mm, but was reduced significantly by 95.9% with the Acutrak 2 Micro screw. Conclusion: When comparing like-sized screws, the CAPTIVATE, Synthes, and Acutrak 2 HCS systems demonstrated similar potential compressive forces. However, compared with the CAPTIVATE Headless and Synthes HCS systems, which are inserted with a compression sleeve that is not gap distance–dependent, the Acutrak 2 HCS system demonstrated less compression when the simulated fracture gap size was increased to 4 mm. [ABSTRACT FROM AUTHOR]

Published
2021
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46. Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation

Author

Vaccaro, Alexander R., primary, Harris, Jonathan A., additional, Hussain, Mir M., additional, Wadhwa, Rishi, additional, Chang, Victor W., additional, Schroerlucke, Samuel R., additional, Samora, Walter P., additional, Passias, Peter G., additional, Patel, Rakesh D., additional, Panchal, Ripul R., additional, D’Agostino, Sabino, additional, Whitney, Nathaniel L., additional, Crawford, Neil R., additional, and Bucklen, Brandon S., additional

Published
2019
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50. Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? : An in vitro biomechanical study

Author

Duff, John, Hussain, Mir M, Klocke, Noelle, Harris, Jonathan A, Yandamuri, Soumya S, Bobinski, Lukas, Daniel, Roy T, Bucklen, Brandon S, Duff, John, Hussain, Mir M, Klocke, Noelle, Harris, Jonathan A, Yandamuri, Soumya S, Bobinski, Lukas, Daniel, Roy T, and Bucklen, Brandon S

Abstract

BACKGROUND: Cervical vertebral body fractures generally are treated through an anterior-posterior approach. Cervical pedicle screws offer an alternative to circumferential fixation. This biomechanical study quantifies whether cervical pedicle screws alone can restore the stability of a three-column vertebral body fracture, making standard 360° reconstruction unnecessary. METHODS: Range of motion (2.0 Nm) in flexion-extension, lateral bending, and axial rotation was tested on 10 cadaveric specimens (five/group) at C2-T1 with a spine kinematics simulator. Specimens were tested for flexibility of intact when a fatigue protocol with instrumentation was used to evaluate construct longevity. For a C4-6 fracture, spines were instrumented with 360° reconstruction (corpectomy spacer + plate + lateral mass screws) (Group 1) or cervical pedicle screw reconstruction (C3 and C7 only) (Group 2). FINDINGS: Results are expressed as percentage of intact (100%). In Group 1, 360° reconstruction resulted in decreased motion during flexion-extension, lateral bending, and axial rotation, to 21.5%, 14.1%, and 48.6%, respectively, following 18,000 cycles of flexion-extension testing. In Group 2, cervical pedicle screw reconstruction led to reduced motion after cyclic flexion-extension testing, to 38.4%, 12.3%, and 51.1% during flexion-extension, lateral bending, and axial rotation, respectively. INTERPRETATION: The 360° stabilization procedure provided the greatest initial stability. Cervical pedicle screw reconstruction resulted in less change in motion following cyclic loading with less variation from specimen to specimen, possibly caused by loosening of the shorter lateral mass screws. Cervical pedicle screw stabilization may be a viable alternative to 360° reconstruction for restoring multilevel vertebral body fracture.

Published
2018
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