Outcomes of stand-alone anterior lumbar interbody fusion of L5–S1 using a novel implant with anterior plate fixation

2020 ◽  
Vol 20 (10) ◽  
pp. 1618-1628
Author(s):  
Marc Szadkowski ◽  
Henri d'Astorg ◽  
Haroun Bouhali ◽  
Ivan Aleksic ◽  
Sonia Ramos-Pascual ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Plate Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Anterior Plate

Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion

2010 ◽  
Vol 12 (4) ◽  
pp. 372-380 ◽  
Author(s):  
Dean G. Karahalios ◽  
Taro Kaibara ◽  
Randall W. Porter ◽  
Udaya K. Kakarla ◽  
Phillip M. Reyes ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Plate Fixation ◽  
Pedicle Screws ◽  
Axial Rotation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Anterior Plate ◽  
Foraminal Height ◽  
Flexion And Extension

Object An interspinous anchor (ISA) provides fixation to the lumbar spine to facilitate fusion. The biomechanical stability provided by the Aspen ISA was studied in applications utilizing an anterior lumbar interbody fusion (ALIF) construct. Methods Seven human cadaveric L3–S1 specimens were tested in the following states: 1) intact; 2) after placing an ISA at L4–5; 3) after ALIF with an ISA; 4) after ALIF with an ISA and anterior screw/plate fixation system; 5) after removing the ISA (ALIF with plate only); 6) after removing the plate (ALIF only); and 7) after applying bilateral pedicle screws and rods. Pure moments (7.5 Nm maximum) were applied in flexion and extension, lateral bending, and axial rotation while recording angular motion optoelectronically. Changes in angulation as well as foraminal height were also measured. Results All instrumentation variances except ALIF alone reduced angular range of motion (ROM) significantly from normal in all directions of loading. The ISA was most effective in limiting flexion and extension (25% of normal) and less effective in reducing lateral bending (71% of normal) and axial rotation (71% of normal). Overall, ALIF with an ISA provided stability that was statistically equivalent to ALIF with bilateral pedicle screws and rods. An ISA-augmented ALIF allowed less ROM than plate-augmented ALIF during flexion, extension, and lateral bending. Use of the ISA resulted in flexion at the index level, with a resultant increase in foraminal height. Compensatory extension at the adjacent levels prevented any significant change in overall sagittal balance. Conclusions When used with ALIF at L4–5, the ISA provides immediate rigid immobilization of the lumbar spine, allowing equivalent ROM to that of a pedicle screw/rod system, and smaller ROM than an anterior plate. When used with ALIF, the ISA may offer an alternative to anterior plate fixation or bilateral pedicle screw/rod constructs.

In vitro biomechanical comparison of an anterior and anterolateral lumbar plate with posterior fixation following single-level anterior lumbar interbody fusion

2007 ◽  
Vol 7 (3) ◽  
pp. 332-335 ◽  
Author(s):  
Wesley M. Johnson ◽  
Tann A. Nichols ◽  
Deepika Jethwani ◽  
Bernard H. Guiot
Keyword(s):  
Interbody Fusion ◽  
Plate Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Anterior Plate ◽  
Axial Torsion ◽  
Flexion Extension

Object Anterior lumbar interbody fusion (ALIF) is often supplemented with instrumentation to increase stability in the spine. If anterior plate fixation provided the same stability as posterior pedicle screw fixation (PSF), then a second approach and its associated morbidity could be avoided. Methods Seven human cadaveric L4–5 spinal segments were tested under three conditions: ALIF with an anterior plate, ALIF with an anterolateral plate, and ALIF supplemented by PSF. Range of motion (ROM) was calculated for flexion/extension, lateral bending, and axial torsion and compared among the three configurations. Results There were no significant differences in ROM during flexion/extension, lateral bending, or axial torsion among any of the three instrumentation configurations. Conclusions The addition of an anterior plate or posterior PS/rod instrumentation following ALIF provides substantially equivalent biomechanical stability. Additionally, the position of the plate system, either anterior or anterolateral, does not significantly affect the stability gained.

Augmentation of an anterior lumbar interbody fusion with an anterior plate or pedicle screw fixation: a comparative biomechanical in vitro study

2007 ◽  
Vol 6 (3) ◽  
pp. 267-271 ◽  
Author(s):  
Tann A. Nichols ◽  
Brenda K. Yantzer ◽  
Suzanne Alameda ◽  
Wesley M. Johnson ◽  
Bernard H. Guiot
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Anterior Plate ◽  
Elastic Zone ◽  
Flexion Extension

Object Posterior pedicle screw (PS) instrumentation is often used to augment anterior lumbar interbody fusion (ALIF) but at the cost of an increase in the morbidity rate due to the second approach and screw placement. If anterior plates were found to be biomechanically equivalent to PS fixation (PSF) after ALIF, then this second approach could be avoided without decreasing vertebral stability. Methods Eight cadaveric L5–S1 spinal segments were tested under four conditions: intact, following anterior discectomy and interbody spacer placement, after placement of an anterior plate, and following PSF. The elastic zone and stiffness were calculated for axial compression, flexion/extension, lateral bending, and torsion. Neither anterior plate stabilization nor PSF showed significant intergroup differences in stiffness or the elastic zone. Both exhibited greater stiffness in flexion than the intact specimens (p < 0.001). Pedicle screw fixation was associated with a decreased elastic zone in lateral bending compared with the intact specimen (p < 0.04). Conclusions Anterior plate fixation is biomechanically similar to PSF following ALIF. Surgeons may wish to use anterior plates in place of PSs to avoid the need for a posterior procedure. This may lead to a decrease in operative morbidity and improved overall outcomes.

Comparison of CD HORIZON SPIRE spinous process plate stabilization and pedicle screw fixation after anterior lumbar interbody fusion

2006 ◽  
Vol 4 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Jeremy C. Wang ◽  
Regis W. Haid ◽  
Jay S. Miller ◽  
James C. Robinson
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Operative Time ◽  
Plate Fixation ◽  
Spinous Process ◽  
Anterior Lumbar Interbody Fusion ◽  
Open Approach ◽  
Lumbar Interbody Fusion ◽  
Hardware Failure ◽  
Estimated Blood Loss

Object The authors present the early clinical results obtained in patients who underwent SPIRE spinous process plate fixation following anterior lumbar interbody fusion (ALIF). Methods Between May 2003 and January 2005, 32 patients underwent titanium cage and bone morphogenetic protein–augmented ALIF and subsequent SPIRE (21 cases) or bilateral pedicle screw (BPS; 11 cases) fixation. Pedicle screws were implanted using either the open approach (three cases) or using a tubular retractor (eight cases). Patients’ charts were reviewed for operative time, estimated blood loss (EBL), hospital length of stay (LOS), and evidence of pseudarthrosis or hardware failure. In SPIRE plate–treated patients, the median EBL (75 ml) was lower than in BPS-treated patients (open BPS [150 ml]; tubular BPS [125 ml]). The median operative time in SPIRE plate–treated patients was also shorter (164 minutes compared with 239 and 250 minutes in the open and tubular BPS, respectively). The median LOS was 3 days for both the SPIRE and tubular BPS groups, but 4 days in the open BPS group. There were no instances of major surgery-induced complication, pseudarthrosis, or hardware failure during mean follow-up periods of 5.5, 7.2, and 4.9 months in the SPIRE, open PS, and tubular BPS groups, respectively. Conclusions The SPIRE plate is easy to implant and is associated with minimal operative risk. Compared with BPS/rod constructs, SPIRE plate fixation leads to less EBL and shorter operative time, without an increase in the rate of pseudarthrosis. Hospital LOS was also shorter in SPIRE plate–treated patients, which is consistent with the goals of minimal access spinal technologies.

Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis

2010 ◽  
Vol 12 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Kyeong Hwan Kim ◽  
Sang-Ho Lee ◽  
Dong Yeob Lee ◽  
Chan Shik Shim ◽  
Dae Hyeon Maeng
Keyword(s):  
Vertebral Body ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Cement Augmentation ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Group I ◽  
Cage Subsidence ◽  
The Mean ◽  
Group Ii

Object The purpose of the present study was to evaluate the efficacy of anterior polymethylmethacrylate (PMMA) cement augmentation in instrumented anterior lumbar interbody fusion (ALIF) for patients with osteoporosis. Methods Sixty-two patients with osteoporosis who had undergone single-level instrumented ALIF for spondylolisthesis and were followed for more than 2 years were included in the study. The patients were divided into 2 groups: instrumented ALIF alone (Group I) and instrumented ALIF with anterior PMMA augmentation (Group II). Sixty-one patients were interviewed to evaluate the clinical results, and plain radiographs and 3D CT scans were obtained at the last follow-up in 46 patients. Results The mean degree of cage subsidence was significantly higher in Group I (19.6%) than in Group II (5.2%) (p = 0.001). The mean decrease of vertebral body height at the index level was also significantly higher in Group I (10.7%) than in Group II (3.9%) (p = 0.001). No significant intergroup differences were observed in the incidence of radiographic adjacent-segment degeneration (ASD) or in terms of pain and functional improvement. The incidences of clinical ASD (23% in Group I and 10% in Group II) were not significantly different. There was 1 case of nonunion and 3 cases of screw migration in Group I, but none resulted in implant failure. Conclusions Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.

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