scholarly journals In vitro biomechanical effects of reconstruction on adjacent motion segment: comparison of aligned/kyphotic posterolateral fusion with aligned posterior lumbar interbody fusion/posterolateral fusion

2003 ◽  
Vol 99 (2) ◽  
pp. 221-228 ◽  
Author(s):  
Hideki Sudo ◽  
Itaru Oda ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Yoshihisa Kotani ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Posterolateral Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Motion Segment ◽  
Flexion Extension ◽  
Fine Print

Object. Posterior lumbar interbody fusion (PLIF) was developed to overcome the limitations of posterolateral fusion in correcting spinal deformity and maintaining lumbar lordosis. In this study the authors compare the biomechanical effects of three different posterior reconstructions on the adjacent motion segment. Methods. Ten calf spinal (L2—S1) specimens underwent nondestructive flexion—extension testing (± 6 Nm). The specimens were destabilized at the L5—S1 levels after intact testing. This was followed by pedicle screw fixation with and without interbody cages as follows: 1) with straight rods (“aligned” posterolateral fusion); 2) with kyphotically prebent rods (“kyphotic” posterolateral fusion); and 3) with interbody cages combined with straight rods (“aligned” PLIF/posterolateral fusion). The range of motion (ROM) of the operative segments, the intradiscal pressure (IDP), and longitudinal lamina strain in the superior adjacent segment (L4–5) were analyzed. The ROM associated with aligned PLIF/posterolateral fusion-treated specimens was significantly less than both the aligned and kyphotic posterolateral fusion-treated procedures in both flexion and extension loading (p < 0.05). The aligned PLIF/posterolateral fusion was associated with greater IDP and the lamina strain compared with the aligned and kyphotic posterolateral fusion groups in flexion loading. Under extension loading, greater IDP and lamina strain were present in the kyphotic posterolateral fusion group than in the aligned posterolateral fusion group. The highest IDP and lamina strain were shown in the aligned PLIF/posterolateral fusion group. Conclusions. Compared with kyphotic posterolateral fusion, PLIF may lead to even higher load at the superior adjacent level because of the increased stiffness of the fixed segments even if local kyphosis is corrected by PLIF.

Stabilizing effect of posterior lumbar interbody fusion cages before and after cyclic loading

2000 ◽  
Vol 92 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Annette Kettler ◽  
Hans-Joachim Wilke ◽  
Rupert Dietl ◽  
Matthias Krammer ◽  
Christianto Lumenta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Axial Rotation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Flexion Extension ◽  
Stabilizing Effect ◽  
Fine Print

Object. The function of interbody fusion cages is to stabilize spinal segments primarily by distracting them as well as by allowing bone ingrowth and fusion. An important condition for efficient formation of bone tissue is achieving adequate spinal stability. However, the initial stability may be reduced due to repeated movements of the spine during everyday activity. Therefore, in addition to immediate stability, stability after cyclic loading is of remarkable relevance; however, this has not yet been investigated. The object of this study was to investigate the immediate stabilizing effect of three different posterior lumbar interbody fusion cages and to clarify the effect of cyclic loading on the stabilization. Methods. Before and directly after implantation of a Zientek, Stryker, or Ray posterior lumbar interbody fusion cage, 24 lumbar spine segment specimens were each evaluated in a spine tester. Pure lateral bending, flexion—extension, and axial rotation moments (± 7.5 Nm) were applied continuously. The motion in each specimen was measured simultaneously. The specimens were then loaded cyclically (40,000 cycles, 5 Hz) with an axial compression force ranging from 200 to 1000 N. Finally, they were tested once again in the spine tester. Conclusions. In general, a decrease of movement in all loading directions was noted after insertion of the Zientek and Ray cages and an increase of movement after implantation of a Stryker cage. In all three cage groups greater stability was demonstrated in lateral bending and flexion than in extension and axial rotation. Reduced stability during cyclic loading was observed in all three cage groups; however, loss of stability was most pronounced when the Ray cage was used.

Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?

2003 ◽  
Vol 99 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Giovanni La Rosa ◽  
Alfredo Conti ◽  
Fabio Cacciola ◽  
Salvatore Cardali ◽  
Domenico La Torre ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Pedicle Screw Fixation ◽  
Posterolateral Fusion ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Content Type ◽  
Fine Print

Object. Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. Methods. Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion—only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). Conclusions. The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.

Complications of posterior lumbar interbody fusion when using a titanium threaded cage device

2000 ◽  
Vol 93 (1) ◽  
pp. 45-52 ◽  
Author(s):  
W. Jeffrey Elias ◽  
Nathan E. Simmons ◽  
George J. Kaptain ◽  
James B. Chadduck ◽  
Richard Whitehill
Keyword(s):  
Back Pain ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Motor Deficit ◽  
Spinal Instability ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The authors reviewed their series of patients to quantify clinical and radiographic complications in those who underwent a posterior lumbar interbody fusion (PLIF) procedure in which a threaded interbody cage (TIC) was implanted. Methods. Sixty-seven patients underwent a posterior lumbar interbody fusion procedure in which a TIC was used. The authors excluded patients who underwent procedures in which other instrumentation was used or a nondorsal approach was performed. Fifteen percent of the cases (10 patients) were complicated by laceration of the dura. In three cases, bilateral implantation could not be performed. The average blood loss was 670 ml for all cases, and blood transfusion was required in 25% of the cases (17 patients). The rate of minor wound complication was 4.5% (three patients). One patient died. The average period of hospitalization was 4.25 days. Twenty-eight patients (42%) experienced significant low-back pain 3 months postoperatively, and in 10 (15%) of these cases it persisted beyond 1 year. In 10 patients postoperative radiculopathy was demonstrated, and magnetic resonance imaging revealed epidural fibrosis in six patients, arachnoiditis in one, and a recurrent disc herniation in one. One patient incurred a permanent motor deficit with sexual dysfunction. Pseudarthrosis was suggested radiographically with evidence of motion on lateral flexion—extension radiographs (10 cases), lucencies around the implants (seven cases), and posterior migration of the cage (two cases). Additional procedures (in 14 patients) consisted primarily of transverse process fusion with pedicle screw and plate augmentation for persistent back pain and radiographically demonstrated signs of spinal instability. In two patients with radiculopathy, migration of the TIC required that it be removed. Graft material that extruded from one implant necessitated its removal. In one patient scarectomy was performed. Conclusions. Our high incidence of TIC-related complications in PLIF is inconsistent with that reported in previous studies.

Posterior lumbar interbody fusion with cages: an independent review of 71 cases

1999 ◽  
Vol 91 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Siviero Agazzi ◽  
Alain Reverdin ◽  
Daniel May
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Fixation Techniques ◽  
Independent Review ◽  
Fine Print

Object. The authors conducted a retrospective study to provide an independent evaluation of posterior lumbar interbody fusion (PLIF) in which impacted carbon cages were used. Interbody cages have been developed to replace tricortical interbody grafts in anterior and PLIF procedures. Superior fusion rates and clinical outcomes have been claimed by the developers. Methods. In a retrospective study, the authors evaluated 71 consecutive patients in whom surgery was performed between 1995 and 1997. The median follow-up period was 28 months. Clinical outcome was assessed using the Prolo scale. Fusion results were interpreted by an independent radiologist. The fusion rate was 90%. Overall, 67% of the patients were satisfied with their outcome and would undergo the same operation again. Based on the results of the Prolo scale, however, in only 39% of the patients were excellent or good results achieved. Forty-six percent of the work-eligible patients resumed their working activity. Clinical outcome and return-to-work status were significantly associated with socioeconomic factors such as preoperative employment (p = 0.03), compensation issues (p = 0.001), and length of preoperative sick leave (p = 0.01). Radiographically demonstrated fusion was not statistically related to clinical outcome (p = 0.2). Conclusions. This is one of the largest independent series in which PLIF with cages has been evaluated. The results show that the procedure is safe and effective with a 90% fusion rate and a 66% overall satisfaction rate, which compare favorably with those of traditional fixation techniques but fail to match the higher results claimed by the innovators of the cage techniques. The authors' experience confirms the reports of others that many patients continue to experience incapacitating back pain despite successful fusion and neurological recovery.

In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices

2000 ◽  
Vol 93 (2) ◽  
pp. 259-265 ◽  
Author(s):  
Masahiro Kanayama ◽  
Bryan W. Cunningham ◽  
Charles J. Haggerty ◽  
Kuniyoshi Abumi ◽  
Kiyoshi Kaneda ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Stress Shielding ◽  
Shielding Effect ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Different Types ◽  
Spine Model ◽  
Structural Allografts ◽  
Fine Print

Object. Interbody fusion devices are rapidly gaining acceptance as a method of ensuring lumbar interbody arthrodesis. Although different types of devices have been developed, the comparative reconstruction stability remains controversial. It also remains unclear how different stress-shielded environments are created within the devices. Using a calf spine model, this study was designed to compare the construct stiffness afforded by 11 differently designed lumbar interbody fusion devices and to quantify their stress-shielding effects by measuring pressure within the devices. Methods. Sixty-six lumbar specimens obtained from calves were subjected to anterior interbody reconstruction at L4–5 by using one of the following interbody fusion devices: four different threaded fusion cages (BAK device, BAK Proximity, Ray TFC, and Danek TIBFD), five different nonthreaded fusion devices (oval and circular Harms cages, Brantigan PLIF and ALIF cages, and InFix device); two different types of allograft (femoral ring and bone dowel) were used. Construct stiffness was evaluated in axial compression, torsion, flexion, and lateral bending. Prior to testing, a silicon elastomer was injected into the cages and intracage pressures were measured using pressure needle transducers. Conclusions. No statistical differences were observed in construct stiffness among the threaded cages and nonthreaded devices in most of the testing modalities. Threaded fusion cages demonstrated significantly lower intracage pressures compared with nonthreaded cages and structural allografts. Compared with nonthreaded cages and structural allografts, threaded fusion cages afforded equivalent reconstruction stiffness but provided more stress-shielded environment within the devices.

Clinical analysis of percutaneous facet screw fixation after anterior lumbar interbody fusion

2005 ◽  
Vol 3 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Control Group ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Flexion Extension ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

Object. The authors performed a retrospective study to evaluate the results of percutaneous facet screw fixation (PFSF) after anterior lumbar interbody fusion (ALIF) in comparison with the gold standard, post-ALIF pedicle screw fixation (PSF). Methods. Of 84 patients treated for degenerative spondylolisthesis or degenerative disc disease at the authors' institution, 44 underwent PFSF (Group 1) and 40 underwent PSF (Group 2 [control population]) after ALIF. Function was assessed using the Oswestry Disability Index (ODI) scoring system, and outcome was measured using the Macnab criteria. At 3, 6, 12, and 24 months after surgery, dynamic lateral (flexion—extension) radiography and computerized tomography scanning were conducted to evaluate the osseous union status. After a minimum follow-up period of 2 years, analysis showed no intergroup statistical difference in terms of ODI score and Macnab outcome criteria (p > 0.05). Excellent or good outcome was obtained in 40 (90.9%) of the 44 patients in Group 1 and 37 (92.5%) of the 40 patients in the control Group 2 (p > 0.05). No patient required a blood transfusion in either group. At 24 months after surgery fusion rates were 95.8% in Group 1 and 97.5% in Group 2. Conclusions. The results of PFSF following ALIF appear to be clinically equivalent to those achieved after PSF, and the procedure represents a safe and minimally invasive modality with which to achieve solid fusion in the lumbar spine.

scholarly journals Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation

2015 ◽  
Vol 23 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Kang Lu ◽  
Po-Chou Liliang ◽  
Hao-Kuang Wang ◽  
Cheng-Loong Liang ◽  
Jui-Sheng Chen ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Flexion Extension ◽  
Second Surgery ◽  
Group A ◽  
Group B ◽  
Interspinous Process Device

OBJECTMultilevel long-segment lumbar fusion poses a high risk for future development of adjacent-segment degeneration (ASD). Creating a dynamic transition zone with an interspinous process device (IPD) proximal to the fusion has recently been applied as a method to reduce the occurrence of ASD. The authors report their experience with the Device for Intervertebral Assisted Motion (DIAM) implanted proximal to multilevel posterior lumbar interbody fusion (PLIF) in reducing the development of proximal ASD.METHODSThis retrospective study reviewed 91 cases involving patients who underwent 2-level (L4–S1), 3-level (L3–S1), or 4-level (L2–S1) PLIF. In Group A (42 cases), the patients received PLIF only, while in Group B (49 cases), an interspinous process device, a DIAM implant, was put at the adjacent level proximal to the PLIF construct. Bone resection at the uppermost segment of the PLIF was equally limited in the 2 groups, with preservation of the upper portion of the spinous process/lamina and the attached supraspinous ligament. Outcome measures included a visual analog scale (VAS) for low-back pain and leg pain and the Oswestry Disability Index (ODI) for functional impairment. Anteroposterior and lateral flexion/extension radiographs were used to evaluate the fusion status, presence and patterns of ASD, and mobility of the DIAM-implanted segment.RESULTSSolid interbody fusion without implant failure was observed in all cases. Radiographic ASD occurred in 20 (48%) of Group A cases and 3 (6%) of Group B cases (p < 0.001). Among the patients in whom ASD was identified, 9 in Group A and 3 in Group B were symptomatic; of these patients, 3 in Group A and 1 in Group B underwent a second surgery for severe symptomatic ASD. At 24 months after surgery, Group A patients fared worse than Group B, showing higher mean VAS and ODI scores due to symptoms related to ASD. At the final follow-up evaluations, as reoperations had been performed to treat symptomatic ASD in some patients, significant differences no longer existed between the 2 groups. In Group B, flexion/extension mobility at the DIAM-implanted segment was maintained in 35 patients and restricted or lost in 14 patients, 5 of whom had already lost segmental flexion/extension mobility before surgery. No patient in Group B developed ASD at the segment proximal to the DIAM implant.CONCLUSIONSProviding a dynamic transition zone with a DIAM implant placed immediately proximal to a multilevel PLIF construct was associated with a significant reduction in the occurrence of radiographic ASD, compared with PLIF alone. Given the relatively old age and more advanced degeneration in patients undergoing multilevel PLIF, this strategy appears to be effective in lowering the risk of clinical ASD and a second surgery subsequent to PLIF.

Posterior lumbar interbody fusion for revision disc surgery: review of 50 cases in which carbon fiber cages were implanted

2001 ◽  
Vol 95 (2) ◽  
pp. 190-195 ◽  
Author(s):  
Bhupal Chitnavis ◽  
Giuseppe Barbagallo ◽  
Richard Selway ◽  
Ronan Dardis ◽  
Ahmed Hussain ◽  
...  
Keyword(s):  
Back Pain ◽  
Carbon Fiber ◽  
Interbody Fusion ◽  
Clinical Success ◽  
Pedicle Screws ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Fine Print

Object. The authors undertook a study to assess the value of posterior lumbar interbody fusion (PLIF) in which carbon fiber cages (CFCs) were placed in patients undergoing revision disc surgery for symptoms suggesting neural compression with low-back pain. Methods. The authors followed their first 50 patients for a maximum of 5 years and a minimum of 6 months after implantation of the CFCs. Patients in whom magnetic resonance (MR) imaging demonstrated “simple” recurrent herniation did not undergo PLIF. Surgery was performed in patients with symptoms of neural root compression, tension signs, and back pain with focal disc degeneration and nerve root distortion depicted on MR imaging compatible with clinical signs and symptoms. In 40 patients (80%) pedicle screws were not used. Clinical outcome was assessed using the Prolo Functional Economic Outcome Rating scale. Fusion outcome was assessed using an established classification. Symptoms in 46 patients (92%) improved after surgery, and given their outcomes, 45 (90%) would have undergone the same surgery again. Two thirds of patients experienced good or excellent outcomes (Prolo score ≥ 8) at early and late follow up. There was no difference in clinical outcome between those in whom pedicle screws were and were not implanted (p = 0.83, Mann—Whitney U-test). The fusion rate at 2 years postsurgery was 95%. There were minimal complications, and no patients fared worse after surgery. No patient has undergone additional surgical treratment of the fused intervertebral space. Conclusions. In this difficult group of patients the aim remains to improve symptoms but not cure the disease. A high fusion rate is possible when using the CFCs. Clinical success depends on selecting patients in whom radiological and clinical criteria accord. Pedicle screws are not necessary if facet joints are preserved, and high fusion rates and clinical success are possible without them.

Bioabsorbable anterior lumbar plate fixation in conjunction with cage-assisted anterior interbody fusion

2002 ◽  
Vol 97 (4) ◽  
pp. 447-455 ◽  
Author(s):  
Denis J. DiAngelo ◽  
Jeffrey L. Scifert ◽  
Scott Kitchel ◽  
G. Bryan Cornwall ◽  
Bobby J. McVay
Keyword(s):  
Interbody Fusion ◽  
Plate Fixation ◽  
Axial Rotation ◽  
Biomechanical Study ◽  
Local Motion ◽  
Content Type ◽  
Flexion Extension ◽  
Spine Model ◽  
Fine Print

Object. An in vitro biomechanical study was conducted to determine the effects of anterior stabilization on cage-assisted lumbar interbody fusion biomechanics in a multilevel human cadaveric lumbar spine model. Methods. Three spine conditions were compared: harvested, bilateral multilevel cages (CAGES), and CAGES with bioabsorbable anterior plates (CBAP), tested under flexion—extension, lateral bending, and axial rotation. Measurements included vertebral motion, applied load, and bending/rotational moments. Application of anterior fixation decreased local motion and increased stiffness of the instrumented levels. Clinically, this spinal stability may serve to promote fusion. Conclusions. Coupled with the bioabsorbability of the plating material, the bioabsorbable anterior lumbar plating system is considered biomechanically advantageous.

Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages

2002 ◽  
Vol 96 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Christopher E. Wolfla ◽  
Dennis J. Maiman ◽  
Frank J. Coufal ◽  
James R. Wallace
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Anterior Longitudinal Ligament ◽  
Content Type ◽  
Single Cage ◽  
Novel Technique ◽  
Methodological Problems ◽  
Fine Print

Object. Intertransverse arthrodesis in which instrumentation is placed is associated with an excellent fusion rate; however, treatment of patients with symptomatic nonunion presents a number of difficulties. Revision posterior and traditional anterior procedures are associated with methodological problems. For example, in the latter, manipulation of the major vessels from L-2 to L-4 may be undesirable. The authors describe a method for performing retroperitoneal lumbar interbody fusion (LIF) in which a threaded cage is placed from L-2 through L-5 via a lateral trajectory, and they also detail a novel technique for implanting a cage from L-5 to S-1 via an oblique trajectory. Although they present data obtained over a 2-year period in the study of 15 patients, the focus of this report is primarily on describing the surgical procedure. Methods. The lateral lumbar spine was exposed via a standard retroperitoneal approach. Using the anterior longitudinal ligament as a landmark, the L2–3 through L4–5 levels were fitted with instrumentation via a true lateral trajectory; the L5—S1 level was fitted with instrumentation via an oblique trajectory. A single cage was placed at each instrumented level. Fifteen symptomatic patients in whom previous lumbar fusion had failed underwent retroperitoneal LIF. Thirty-eight levels were fitted with instrumentation. There have been no instrumentation-related failures, and fusion has occurred at 37 levels during the 2-year postoperative period. Conclusions. The use of retroperitoneal LIF in which threaded fusion cages are used avoids the technical difficulties associated with repeated posterior procedures. In addition, it allows L2—S1 instrumentation to be placed anteriorly via a single surgical approach. This construct has been shown to be biomechanically sound in animal models, and it appears to be a useful alternative for the management of failed multilevel intertransverse arthrodesis.

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