skipping cross-links in posterior spine surgery: a review

Background and aim: given the conflicting and unreliable evidence for using cross-links in posterior spine surgery, this review was conducted to highlight the different features and usefulness of these augmentation devices in spine surgeries. methods and materials/patients: after searching databases using specific keywords, the relevant articles were ultimately selected and evaluated. results: biomechanically investigating the use of cross-links has not resulted in unanimous explanations for their effect. the site and direction of cross-links have been rarely investigated in the literature. some studies recommended eliminating their application from clinical practice; nevertheless, these studies do not necessarily yield clinical benefits. posterior spinal fixation with pedicle screws and without cross-links offers stability in all the planes in most clinical conditions. conclusion: excluding the cross-links in posterior spine surgery may shorten the operation time and reduce hospital costs. researchers have reported other problems for cross-links such as late pain, device failure, infections, device prominence, and pseudarthrosis which may be obliterated through the avoidance of their combination in a spinal construct; nevertheless, the results of animal models of the application of special cross-links in a degenerative disorder or deformity suggest that diagonal cross-links provide the highest stability of the construct if they are matched with a rodonly system or with transverse cross-link constructs resulting in a rectangular configuration.