Biomechanical Evaluation and preliminary clinical results of Anterolateral Screw Fixation for Oblique Lumbar Interbody Fusion Surgery

Abstract Background: The most common complication of oblique lumbar interbody fusion (OLIF) is cage subsidence. OLIF combined with internal fixation could help decrease the cage subsidence and increase the fusion rate. The aim of this study was to evaluate the biomechanical feasibility and safety in the patients undergoing OLIF surgery with anterolateral screw fixation (ASF). Methods: Based on our previous validated model , L4-L5 functional surgical models corresponding to the ASF and Bilateral pedicle screw fixation(BPSF) methods were created. A 500 N compression force was applied to the superior surface of the model to represent the upper body weight, and a 7.5 Nm moment was applied to simulate the six movement directions of the lumbar spinal model: flexion/extension, right/left lateral bending and right/left axial rotation. Finite element (FE) models were developed to compare the biomechanics of the ASF and BPSF groups. Results: Compared to the range of motion (ROM) of the intact lumbar model, that of the ASF model was decreased by 82.0% in flexion, 60.0% in extension, and the BPSF model was decreased by 86.7% in flexion, 77.3% in extension. Compared to the BPSF model, the maximum stresses of the L4 inferior endplate (IEP) and L5 superior endplate (SEP) were greatly increased in the ASF model; The contact surface between vertebrae and screw (CSVS) in the ASF model produced nearly100% more stresses than the BPSF model in all moment .Conclusions: OLIF surgery with ASF could not reduce the maximum stresses on the endplate and CSVS, which may be a potential risk factor for cage subsidence and screw loosening.

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Symptomatic contralateral osteophyte fracture with migration causing lumbar plexopathy during oblique lumbar interbody fusion: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21210 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Brenton Pennicooke ◽

Jeremy Guinn ◽

Dean Chou

Keyword(s):

Interbody Fusion ◽

Psoas Muscle ◽

Surgical Excision ◽

Contralateral Side ◽

Illustrative Case ◽

Lumbar Interbody Fusion ◽

Fusion Surgery ◽

Lateral Lumbar Interbody Fusion ◽

Bony Fragment ◽

Oblique Lumbar Interbody Fusion

BACKGROUND While performing lateral lumbar interbody fusion surgery, one of the surgical goals is to release the contralateral side with a Cobb elevator, allowing distraction of the interbody space. Many times, there are large osteophytes on the contralateral side, and the osteophytes can be split open with the Cobb or blunt instrument. It is extremely rare for the actual osteophyte to break off from the vertebral body into the contralateral psoas muscle and lumbar plexus. OBSERVATIONS The authors report a case of symptomatic lumbar plexopathy caused by an osteophyte fracture after an oblique lumbar interbody fusion requiring a right-sided anterior approach to excise the bony fragment. They illustrate the case with imaging that the radiologist did not comment on, and they also show a video of the surgical excision of the osteophyte through a right-sided anterior lumbar retroperitoneal approach. The authors also show how the patient had spontaneous right-sided electromyography (EMG) firing before excision of the osteophyte and how the EMG firing resolved after excision. LESSONS Although the literature is plentiful with regard to ipsilateral approach–related complications, the authors discuss the literature with regard to contralateral complications after minimally invasive lateral lumbar interbody fusion.

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Effects of Lordotic Angle of a Cage on Sagittal Alignment and Clinical Outcome in One Level Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation

BioMed Research International ◽

10.1155/2015/523728 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ji-Ho Lee ◽

Dong-Oh Lee ◽

Jae Hyup Lee ◽

Hee Jong Shim

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Screw Fixation ◽

Posterior Lumbar Interbody Fusion ◽

Clinical Results ◽

Pedicle Screw Fixation ◽

Low Back ◽

Lumbar Interbody Fusion ◽

Segmental Lordosis

This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups.

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