Revision of transforaminal lumbar interbody fusion using anterior lumbar interbody fusion: a biomechanical study in nonosteoporotic bone

2010 ◽  
Vol 12 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Avraam Ploumis ◽  
Chunhui Wu ◽  
Amir Mehbod ◽  
Gustav Fischer ◽  
Antonio Faundez ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Mineral Density ◽  
Normal Bone Mineral Density ◽  
Flexion Extension

Object Transforaminal lumbar interbody fusion (TLIF) is a popular fusion technique for treating chronic low-back pain. In cases of interbody nonfusion, revision techniques for TLIF include anterior lumbar interbody fusion (ALIF) approaches. Biomechanical data of the revision techniques are not available. The purpose of this study was to compare the immediate construct stability, in terms of range of motion (ROM) and neutral zone (NZ), of a revision ALIF procedure for an unsuccessful TLIF. An in vitro biomechanical comparison of TLIF and its ALIF revision procedure was conducted on cadaveric nonosteoporotic human spine segments. Methods Twelve cadaveric lumbar motion segments with normal bone mineral density were loaded in unconstrained axial torsion, lateral bending, and flexion-extension under 0.05 Hz and ± 6-nm sinusoidal waveform. The specimens underwent TLIF (with posterior pedicle fixation) and anterior ALIF (with intact posterior fixation). Multidirectional flexibility testing was conducted following each step. The ROM and NZ data were measured and calculated for each test. Results Globally, the TLIF and revision ALIF procedures significantly reduced ROM and NZ compared with that of the intact condition. The revision ALIF procedures achieved similar ROM as the TLIF procedure. Conclusions Revision ALIF maintained biomechanical stability of TLIF in nonosteoporotic spines. Revision ALIF can be performed without sacrificing spinal stability in cases of intact posterior instrumentation.

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.

Tapered cages in anterior lumbar interbody fusion: biomechanics of segmental reactions

2006 ◽  
Vol 5 (4) ◽  
pp. 330-335 ◽  
Author(s):  
Jason Moore ◽  
Narayan Yoganandan ◽  
Frank A. Pintar ◽  
Jason Lifshutz ◽  
Dennis J. Maiman
Keyword(s):  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Related Data ◽  
Flexion Extension ◽  
Before And After ◽  
Bending Modes ◽  
Lumbar Spinal

Object The aim of this study was to determine the in vitro biomechanical responses of lumbar spinal segments after implantation of tapered cages. Methods Range of motion (ROM)– and stiffness-related data were determined in 10 human cadaveric T12–S1 columns subjected to flexion, extension, and lateral bending modes before and after anterior lumbar interbody fusion in which stand-alone LT-CAGE devices were used. The overall column showed no significant changes in ROM or stiffness. At the instrumented level, stiffness increased significantly (p < 0.05) in flexion and lateral bending modes. Indications of instability in extension were present, but these values were not statistically significant. There was no evidence of adjacent-level instability at any level in any mode, except for the segment superior to the fixation level in flexion; here there was a significant increase in ROM (p < 0.05) and a decrease in stiffness. Conclusions The anatomical conformity and bilateral placement of cages provide ample stability and rigidity at the treated level, comparable to that of other cage systems. Because hypermobility is traditionally related to early degenerative changes, the present results appear to suggest that cages do not significantly contribute to such alterations.

Biomechanical analysis of stand-alone lumbar interbody cages versus 360° constructs: an in vitro and finite element investigation

2021 ◽  
pp. 1-9
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Interbody Cage ◽  
Lateral Bending ◽  
Flexion Extension ◽  
Lateral Interbody ◽  
Flexion And Extension

OBJECTIVE Low fusion rates and cage subsidence are limitations of lumbar fixation with stand-alone interbody cages. Various approaches to interbody cage placement exist, yet the need for supplemental posterior fixation is not clear from clinical studies. Therefore, as prospective clinical studies are lacking, a comparison of segmental kinematics, cage properties, and load sharing on vertebral endplates is needed. This laboratory investigation evaluates the mechanical stability and biomechanical properties of various interbody fixation techniques by performing cadaveric and finite element (FE) modeling studies. METHODS An in vitro experiment using 7 fresh-frozen human cadavers was designed to test intact spines with 1) stand-alone lateral interbody cage constructs (lateral interbody fusion, LIF) and 2) LIF supplemented with posterior pedicle screw-rod fixation (360° constructs). FE and kinematic data were used to validate a ligamentous FE model of the lumbopelvic spine. The validated model was then used to evaluate the stability of stand-alone LIF, transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF) cages with and without supplemental posterior fixation at the L4–5 level. The FE models of intact and instrumented cases were subjected to a 400-N compressive preload followed by an 8-Nm bending moment to simulate physiological flexion, extension, bending, and axial rotation. Segmental kinematics and load sharing at the inferior endplate were compared. RESULTS The FE kinematic predictions were consistent with cadaveric data. The range of motion (ROM) in LIF was significantly lower than intact spines for both stand-alone and 360° constructs. The calculated reduction in motion with respect to intact spines for stand-alone constructs ranged from 43% to 66% for TLIF, 67%–82% for LIF, and 69%–86% for ALIF in flexion, extension, lateral bending, and axial rotation. In flexion and extension, the maximum reduction in motion was 70% for ALIF versus 81% in LIF for stand-alone cases. When supplemented with posterior fixation, the corresponding reduction in ROM was 76%–87% for TLIF, 86%–91% for LIF, and 90%–92% for ALIF. The addition of posterior instrumentation resulted in a significant reduction in peak stress at the superior endplate of the inferior segment in all scenarios. CONCLUSIONS Stand-alone ALIF and LIF cages are most effective in providing stability in lateral bending and axial rotation and less so in flexion and extension. Supplemental posterior instrumentation improves stability for all interbody techniques. Comparative clinical data are needed to further define the indications for stand-alone cages in lumbar fusion surgery.

scholarly journals A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

2012 ◽  
Vol 2 (4) ◽  
pp. 195-206 ◽  
Author(s):  
M. J. H. McCarthy ◽  
L. Ng ◽  
G. Vermeersch ◽  
D. Chan
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fusion ◽  
Posterior Fixation ◽  
Anterior Fusion ◽  
Lumbar Interbody Fusion ◽  
Anterior Surgery ◽  
Single Level

Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery–alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery–alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated.

Assessment of L5–S1 anterior lumbar interbody fusion stability in the setting of lengthening posterior instrumentation constructs: a cadaveric biomechanical study

2021 ◽  
pp. 1-9
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Axial Rotation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Fusion Construct ◽  
Flexion Extension

OBJECTIVE Excessive stress and motion at the L5–S1 level can lead to degenerative changes, especially in patients with posterior instrumentation suprajacent to L5. Attention has turned to utilization of L5–S1 anterior lumbar interbody fusion (ALIF) to stabilize the lumbosacral junction. However, questions remain regarding the effectiveness of stand-alone ALIF in the setting of prior posterior instrumented fusions terminating at L5. The purpose of this study was to assess the biomechanical stability of an L5–S1 ALIF with increasing lengths of posterior thoracolumbar constructs. METHODS Seven human cadaveric spines (T9–sacrum) were instrumented with pedicle screws from T10 to L5 and mounted to a 6 degrees-of-freedom robot. Posterior fusion construct lengths (T10–L5, T12–L5, L2–5, and L4–5) were instrumented to each specimen, and torque-fusion level relationships were determined for each construct in flexion-extension, axial rotation, and lateral bending. A stand-alone L5–S1 ALIF was then instrumented, and L5–S1 motion was measured as increasing pure moments (2 to 12 Nm) were applied. Motion reduction was calculated by comparing L5–S1 motion across the ALIF and non-ALIF states. RESULTS The average motion at L5–S1 in axial rotation, flexion-extension, and lateral bending was assessed for each fusion construct with and without ALIF. After adding ALIF to a posterior fusion, L5–S1 motion was significantly reduced relative to the non-ALIF state in all but one fused surgical condition (p < 0.05). Longer fusions with ALIF produced larger L5–S1 motions, and in some cases resulted in motions higher than native state motion. CONCLUSIONS Posterior fusion constructs up to L4–5 could be appropriately stabilized by a stand-alone L5–S1 ALIF when using a nominal threshold of 80% reduction in native motion as a potential positive indicator of fusion. The results of this study allow conclusions to be drawn from a biomechanical standpoint; however, the clinical implications of these data are not well defined. These findings, when taken in appropriate clinical context, can be used to better guide clinicians seeking to treat L5–S1 pathology in patients with prior posterior thoracolumbar constructs.

scholarly journals Biomechanical analysis of an expandable lateral cage and a static transforaminal lumbar interbody fusion cage with posterior instrumentation in an in vitro spondylolisthesis model

2016 ◽  
Vol 24 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Matthew Mantell ◽  
Mathew Cyriac ◽  
Colin M. Haines ◽  
Manasa Gudipally ◽  
Joseph R. O’Brien
Keyword(s):  
Interbody Fusion ◽  
Facet Joint ◽  
Posterior Instrumentation ◽  
Degenerative Spondylolisthesis ◽  
Pedicle Screws ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Biomechanical Analysis ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Flexion Extension

OBJECT Insufficient biomechanical data exist from comparisons of the stability of expandable lateral cages with that of static transforaminal lumbar interbody fusion (TLIF) cages. The purpose of this biomechanical study was to compare the relative rigidity of L4–5 expandable lateral interbody constructs with or without additive pedicle screw fixation with that of L4–5 static TLIF cages in a novel cadaveric spondylolisthesis model. METHODS Eight human cadaver spines were used in this study. A spondylolisthesis model was created at the L4–5 level by creating 2 injuries. First, in each cadaver, a nucleotomy from 2 channels through the anterior side was created. Second, the cartilage of the facet joint was burred down to create a gap of 4 mm. Light-emitting-diode tracking markers were placed at L-3, L-4, L-5, and S-1. Specimens were tested in the following scenarios: intact model, bilateral pedicle screws, expandable lateral 18-mm-wide cage (alone, with unilateral pedicle screws [UPSs], and with bilateral pedicle screws [BPSs]), expandable lateral 22-mm-wide cage (alone, with UPSs, and with BPSs), and TLIF (alone, with UPSs, and with BPSs). Four of the spines were tested with the expandable lateral cages (18-mm cage followed by the 22-mm cage), and 4 of the spines were tested with the TLIF construct. All these constructs were tested in flexion-extension, axial rotation, and lateral bending. RESULTS The TLIF-alone construct was significantly less stable than the 18- and 22-mm-wide lateral lumbar interbody fusion (LLIF) constructs and the TLIF constructs with either UPSs or BPSs. The LLIF constructs alone were significantly less stable than the TLIF construct with BPSs. However, there was no significant difference between the 18-mm LLIF construct with UPSs and the TLIF construct with BPSs in any of the loading modes. CONCLUSIONS Expandable lateral cages with UPSs provide stability equivalent to that of a TLIF construct with BPSs in a degenerative spondylolisthesis model.

Biomechanical comparison of transdiscal fixation and posterior fixation with and without transforaminal lumbar interbody fusion in the treatment of L5–S1 lumbosacral joint

2018 ◽  
Vol 232 (4) ◽  
pp. 371-377 ◽  
Author(s):  
Hakan Özalp ◽  
Mustafa Özkaya ◽  
Onur Yaman ◽  
Teyfik Demir
Keyword(s):  
Pedicle Screw ◽  
Axial Compression ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Fusion Cage ◽  
Interbody Fusion Cage

Transdiscal screw fixation is generally performed in the treatment of high-grade L5–S1 spondylolisthesis. The main thought of the study is that the biomechanical performances of the transdiscal pedicle screw fixation can be identical to standard posterior pedicle screw fixations with or without transforaminal lumbar interbody fusion cage insertion. Lumbosacral portions and pelvises of 45 healthy lambs’ vertebrae were dissected. Animal cadavers were randomly and equally divided into three groups for instrumentation. Three fixation systems, L5–S1 posterior pedicle screw fixation, L5–S1 posterior pedicle screw fixation with transforaminal lumbar interbody fusion cage insertion, and L5–S1 transdiscal pedicle screw fixation, were generated. Axial compression, flexion, and torsion tests were conducted on test samples of each system. In axial compression, L5–S1 transdiscal fixation was less stiff than L5–S1 posterior pedicle screw fixation with transforaminal lumbar interbody fusion cage insertion. There were no significant differences between groups in flexion. Furthermore, L5–S1 posterior fixation was stiffest under torsional loads. When axial compression and flexion loads are taken into consideration, transdiscal fixation can be alternatively used instead of posterior pedicle screw fixation in the treatment of L5–S1 spondylolisthesis because it satisfies enough stability. However, in torsion, posterior fixation is shown as a better option due to its higher stiffness.

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