Should we cross the cross-links (transverse-connectors)?
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:67
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Kulkarni A, Dhruv A, Bassi A
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Introduction: Although numerous biomechanical studies are available in the literature, there has been no clinical study that has evaluated the need for cross-links in clinical situations. About 2000 cross-links are utilized every year in India alone (market sources). Methods: The spinal-constructs of patients of varied etiology that underwent surgery between July-2007 andJuly-2011 without the usage of cross-links were evaluated. The immediate post-operative erect radiographs were compared with the erect-radiographs at the last follow-up by two independent observers (spine fellows not involved in the management of the patients) critically for any rotational instability using the Nash-Moe technique of assessment of vertebral rotation as well as for any ‘parallelogram effect’. The intra-observer and inter-observer reliability was analysed
Results: There were 208 cases included in the study, during the study period; satisfying the criteria. The total number of motion segments fused was 707 ranging from one to 15 involving various etiologies. The average follow-up was 15 months (12 months to 36 months). Barring one patient with a thoraco-lumbar fracture with rotational instability (AO Type C) that had undergone a short-segment fixation, none of the cases demonstrated any rotational instability in the follow-up radiographs. Interestingly, the rotational instability (parallelogrameffect) in that patient got corrected spontaneously once anterior reconstruction was performed. The intraobserver reliability was 100 % and the inter-observer reliability was 92.83%. This variability was in assessing the grade of vertebral rotation only; none of the levels had a change in rotation irrespective of variation in grade assessment in the final post-op radiograph.
Conclusions: This study concludes that utilization of cross-links in clinical practice may be avoidable. The derivations from biomechanical studies do not translate into clinical advantages. Eliminating the usage of crosslinks reduces the operative time as well as the over-all total hospital costs (a single cross-link may cost anywhere between Rs 5000 to Rs 20,000 and surgeons tend to use single or multiple cross-links). At an average cost of Rs 10,000 , considering 2000 cross-links as the approximate number that are utilized in India/ year, about Rs 2,00,00,000 can be saved. At an average time of 15 minutes per cross-link application in a construct, considering 2000 cross-links as the approximate number that are utilized in India, about 2000 X 15minutes = 30,000 minutes of precious time can be saved. Additionally, prominence of implants, corrosion, infection, implant failure and pseudarthrosis are the other complications attributed to cross-links in the literature that can be eliminated by preventing their incorporation in spinal constructs.
|How to Cite this Abstract|
|Kulkarni A, Dhruv A, Bassi A. Should we cross the cross-links (transverse-connectors)? International Journal of Conference Proceedings 2015;(2015):67|