Biomechanical comparison: stability of lateral-approach anterior lumbar interbody fusion and lateral fixation compared with anterior-approach anterior lumbar interbody fusion and posterior fixation in the lower lumbar spine

2005 ◽  
Vol 2 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Sung-Min Kim ◽  
T. Jesse Lim ◽  
Josemaria Paterno ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Transpedicular Fixation ◽  
Lower Lumbar Spine ◽  
Lateral Fixation ◽  
Fine Print

Object. The stability of lateral lumbar interbody graft—augmented fusion and supplementary lateral plate fixation in human cadavers has not been determined. The purpose of this study was to investigate the immediate biomechanical stabilities of the following: 1) femoral ring allograft (FRA)—augmented anterior lumbar interbody fusion (ALIF) after left lateral discectomy combined with additional lateral MACS HMA plate and screw fixation; and 2) ALIF combined with posterior transpedicular fixation after anterior discectomy. Methods. Sixteen human lumbosacral spines were loaded with six modes of motion. The intervertebral motion was measured using a video-based motion-capturing system. The range of motion (ROM) and the neutral zone (NZ) in each loading mode were compared with a maximum of 7.5 Nm. The ROM values for both stand-alone ALIF approaches were similar to those of the intact spine, whereas NZ measurements were higher in most loading modes. No significant intergroup differences were found. The ROM and NZ values for lateral fixation in all modes were significantly lower than those of intact spine, except when NZ was measured in lateral bending. All ROM and NZ values for transpedicular fixation were significantly lower than those for stand-alone anterior ALIF. Transpedicular fixation conferred better stabilization than lateral fixation in flexion, extension, and lateral bending modes. Conclusions. Neither approach to stand-alone FRA-augmented ALIF provided sufficient stabilization, but supplementary instrumentation conferred significant stabilization. The MACS HMA plate and screw fixation system, although inferior to posterior transpedicular fixation, provided adequate stability compared with the intact spine and can serve as a sound alternative to supplementary spinal stabilization.

A biomechanical comparison of supplementary posterior translaminar facet and transfacetopedicular screw fixation after anterior lumbar interbody fusion

2004 ◽  
Vol 1 (1) ◽  
pp. 101-107 ◽  
Author(s):  
Sung-Min Kim ◽  
T. Jesse Lim ◽  
Josemaria Paterno ◽  
Daniel H. Kim
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Good Alternative ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Lumbar Stabilization ◽  
Biomechanical Comparison ◽  
Fine Print

Object. Facet screw fixation is the lowest profile lumbar stabilization method. In this study the immediate biomechanical stability provided by the two different types of fixation are compared: translaminar facet screw (TLFS) and transfacetopedicular screw (TFPS) placement after anterior lumbar interbody fusion (ALIF) using a femoral ring allograft. Both facet screw fixation types were also compared with the gold standard, transpedicular screw and rod (TSR) fixation. Methods. Twenty-four human lumbosacral spines were tested in the following sequence: intact state, after discectomy, after ALIF, and after TLFS, TFPS, or TSR fixation. Intervertebral motions were measured by a video-based motion capture system. The range of motion (ROM) and neutral zone (NZ) were compared for each loading to a maximum of 7.5 Nm. The ROMs for stand-alone ALIFs were less than but similar to those of the intact spine, but NZs were slightly increased in all modes. The ROMs for both TLFS and TFPS fixation were significantly decreased from those of the intact spine in all modes and those of the stand-alone ALIF in flexion and extension. The TLFS and TFPS fixations significantly reduced NZs to below that of the intact spine in all modes. Compared with NZs for ALIF, both types of fixation revealed significantly lower values, except for TLFS placement in lateral bending and TFPS fixation in lateral bending and rotation. There were no significant differences between TLFS and TFPS fixation. There were also no significant differences among both TLFS and TFPS and TSR fixations, except that TFPS was inferior to TSR in lateral bending. Conclusions. Stand-alone ALIF may not provide sufficient stability. Both facet fixations produced significant additional stability and both are comparable to TSR fixation. Although TFPS fixation revealed a slightly inferior result, TFPSs can be placed percutaneously with the assistance of fluoroscopic guidance and it makes the posterior facet fixation minimally invasive. Therefore, the TFPS fixation can be considered as a good alternative to TLFS fixation.

Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion

2003 ◽  
Vol 98 (1) ◽  
pp. 100-103 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Sang Rak Lim
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fixation ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Guide Device ◽  
Fine Print

Because the degree of immediate stabilization provided by cage-assisted anterior lumbar interbody fusion (ALIF) has been shown by several studies to be inadequate, supplementary posterior fixation, such as that created by translaminar or transpedicle screw fixation, is necessary. In this study, the authors studied the ALIF-augmentation procedure in which a special guide device is used to place percutaneously translaminar facet screws in 18 patients with degenerative lumbar disease. The minimum follow-up period was 1 month (mean 6 months, range 1–13 months). Degenerative spondylolisthesis with foraminal stenosis was diagnosed in nine patients, associated degenerative disc disease alone or combined with foraminal stenosis in eight, and recurrent disc herniation in one. Following screw placement, computerized tomography scanning was conducted to evaluate the accuracy of the facet screw positioning. All screws were properly placed. No screw penetrated the spinal canal or injured the neural structures. Excellent or good clinical outcomes were demonstrated in all patients at the last follow up. The use of this guide device for post—ALIF percutaneous translaminar facet screw fixation represents a safe, accurate, and minimally invasive modality with which to achieve immediate solid fixation in the lumbar spine.

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.

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.

Clinical outcomes and complications associated with pedicle screw fixation—augmented lumbar interbody fusion

2004 ◽  
Vol 1 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Dennis J. Rivet ◽  
David Jeck ◽  
James Brennan ◽  
Adrian Epstein ◽  
Carl Lauryssen
Keyword(s):  
Carbon Fiber ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Repeated Surgery ◽  
Fine Print

Object. The authors conducted a prospective study to evaluate the clinical and radiological outcomes and complications associated with uni- and bilateral transforaminal lumbar interbody fusion (TLIF) performed using carbon fiber Brantigan I/F Cages and pedicle screw fixation. Methods. Forty-two consecutive patients who had undergone uni- or bilateral TLIF between February 1999 and July 2000 were prospectively evaluated. Clinical outcome was graded using a modified Prolo Scale, the McGill Pain Index Scale, a follow-up questionnaire, and charts. An independent radiologist assessed radiological outcomes. All patients were followed for at least 1 year. Based on Prolo Scale scores, an excellent or good 1-year outcome was achieved in 73% of patients; 90% of patients responded that they would undergo the procedure again. At 1 year, radiographic fusion was demonstrated in 74% and was statistically related to clinical outcome (p < 0.05). There were no deaths or major hardware failures. Complications requiring repeated surgery included one case of cerebrospinal fluid (CSF) leakage and one case in which the hemovac drain was retained. There were four cases involving minor wound infections, eight involving CSF leaks, and none requiring repeated surgery. On routine follow-up radiography one pedicle screw was found to be broken; the patient remained asymptomatic and fusion occurred. Conclusions. Unilateral and bilateral TLIF involving placement of carbon fiber cages and pedicle screw fixation are effective treatment options in patients with indications for lumbar arthrodesis. The procedures result in acceptable rates of fusion and clinical success, and a minimal incidence of morbidity when performed by an experienced surgeon.

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.

Visceral and vascular complications resulting from anterior lumbar interbody fusion

1999 ◽  
Vol 91 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Viswanathan Rajaraman ◽  
Roy Vingan ◽  
Patrick Roth ◽  
Robert F. Heary ◽  
Lisa Conklin ◽  
...  
Keyword(s):  
General Surgery ◽  
Spinal Surgery ◽  
Interbody Fusion ◽  
Burst Fracture ◽  
Vascular Complications ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Sympathetic Dysfunction ◽  
Fine Print

Object. The literature on abdominal and general surgery—related complications following anterior lumbar interbody fusion (ALIF) is scant. In this retrospective review of 60 patients in whom ALIF was performed at their institutions between 1996 and 1998, the authors detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also discussed. Methods. The study group was composed of 31 men and 29 women whose mean age was 42 years (range 29–71 years). The preoperative diagnosis was discogenic back pain in 33 patients (55%); failed back syndrome in 11 (18.3%); pseudarthrosis in five (8.3%); postlaminectomy syndrome in four (6.6%); spondylolisthesis in three (5%); burst fracture in two (3.3%); and malignancy in two (3.3%). A retroperitoneal approach to the spine was used in 57 of the 60 patients. One interspace was exposed in 28 patients (46.6%), two in 28 (46.6%), and three in four (6.6%). Discectomy and interbody fusion in which the authors placed titanium cages or bone dowels was performed in 56 patients and corpectomy with instrumentation in four. Seven (11.6%) of 60 patients had undergone previous abdominal surgery and 29 (48.3%) had undergone previous spinal surgery. The follow-up period averaged 12 ± 4 months (mean ± standard deviation). Twenty-four general surgery—related complications occurred in 23 patients (38.3%), including sympathetic dysfunction in six; vascular injury in four; somatic neural injury in three; sexual dysfunction in three; prolonged ileus in three; wound incompetence in two; and deep venous thrombosis, acute pancreatitis, and bowel injury in one patient each. There were no deaths. The incidence of complications was not associated with underlying diagnosis (p > 0.1), age (p > 0.5), previous abdominal or spinal surgery (p > 0.1), or the number of levels exposed (p > 0.1). Conclusions. This report provides a detailed analysis of the general surgery—related complications following ALIF. Although many of these complications have been recognized in the literature, the significance of sympathetic dysfunction appears to have been underestimated. The high incidence of complications in this series likely reflects the strict criteria. Many of these complications were minor and resolved over time without long-term sequelae.

Bone morphogenetic proteins in anterior lumbar interbody fusion: old techniques and new technologies

2004 ◽  
Vol 1 (3) ◽  
pp. 254-260 ◽  
Author(s):  
J. Kenneth Burkus
Keyword(s):  
Interbody Fusion ◽  
New Technologies ◽  
Anterior Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Iliac Crest Bone Graft ◽  
Lumbar Interbody Fusion ◽  
Success Rates ◽  
Content Type ◽  
Absorbable Collagen Sponge ◽  
Fine Print

Object. The author reports the clinical and radiographic outcomes obtained in three prospective multicenter clinical trials in which recombinant human bone morphogenetic protein—2 (rhBMP-2) was used in anterior lumbar interbody fusion (ALIF). Methods. Stand-alone interbody fusion cages were used, and supplemental fixation was not performed as part of the study protocol. Patients were randomly assigned to one of two ALIF groups: one in which autologous iliac crest bone graft was used (control) and one in which an rhBMP-2—coated absorbable collagen sponge was placed (investigational group). In all patients who underwent rhBMP-2—augmented fusion, imaging demonstrated evidence of bone induction and early incorporation of the cortical allografts. Overall, more expedient clinical improvements and higher success rates were observed in the rhBMP-2 group. Conclusions. In these studies it was shown that rhBMP-2 is a safe and effective material for facilitating ALIF and for decreasing pain and improving clinical outcomes.

The Wilhelm Tell technique for anterior lumbar interbody fusion

2003 ◽  
Vol 98 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Thomas-Marc Markwalder ◽  
Markus Wenger ◽  
Jean-Pierre Elsig ◽  
Etienne Laloux
Keyword(s):  
Carbon Fiber ◽  
Interbody Fusion ◽  
Fiber Composite ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lumbosacral Junction ◽  
Interbody Cage ◽  
Carbon Fiber Composite ◽  
Content Type ◽  
Fine Print

✓ Experience indicates that stand-alone cages may lack the necessary stability to secure highly unstable motion segments at the lumbosacral junction. The authors have designed a special carbon fiber composite interbody cage that allows additional screw placement in anterior lumbar interbody fusion procedures performed at the lumbosacral junction.

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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