MIS Expandable Interbody Spacers

Cannestra, Andrew F.; Peterson, Mark D.; Parker, Stephen; Roush, Thomas F.; Bundy, Justin; Turner, Alexander W.

doi:10.1097/brs.0000000000001465

Cited by 24 publications

(13 citation statements)

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“…To date, there has been no kinematic evaluation of vertically expandable TLIF spacer designs. However, our results using a static PEEK TLIF spacer in combination with bilateral pedicle fixation are consistent with previous cadaveric biomechanical studies [ 23 - 26 ]. Cho et al [ 23 ] found that BPS with static, nonarticulating TLIF spacer reduced intact motion to 25%, 31%, and 60% in FE, LB, and AR, respectively, compared with 41%, 41%, and 62%, respectively, in the present study.…”

Section: Discussionsupporting

confidence: 92%

In Vitro Biomechanical and Fluoroscopic Study of a Continuously Expandable Interbody Spacer Concerning Its Role in Insertion Force and Segmental Kinematics

et al. 2018

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Study DesignIn vitro cadaveric study.PurposeTo compare biomechanical performance, trial and implant insertion, and disc distraction during implant placement, when two interbody devices, an in situ continuously expandable spacer (CES) and a traditional static spacer (SS), were used for transforaminal lumbar interbody fusion.Overview of LiteratureSevere degenerative disc diseases necessitate surgical management via large spacers to increase the disc space for implants. Next-generation interbody devices that expand in situ minimize insertion forces, optimize fit between vertebral endplates, and limit nerve root retraction. However, the literature lacks characterization of insertion forces as well as details on other parameters of expandable and static spacers.MethodsTen cadaveric segments (L5–S1) were divided into two groups (n=5) and implanted with either CES or SS. Each specimen experienced unconstrained pure moment of ±6 Nm in flexion–extension, lateral bending, and axial rotation to assess the contribution of CES and SS implants in biomechanical performance. Radiographic analysis was performed during trial and implant insertion to measure distraction during spacer insertion at the posterior, central, and anterior disc regions. Pressure sensors measured the force of trial and implant insertion.ResultsBiomechanical analysis showed no significant differences between CES and SS in all planes of motion. A total 2.6±0.9 strikes were required for expandable spacer trials insertion and 2.6±0.5 strikes for CES insertion. A total of 8.4±3.8 strikes were required to insert SS trials and 4.2±1.6 strikes for SS insertion. The total force per surgery was 330 N for CES and 635 N for SS. Fluoroscopic analysis revealed a significant reduction in distraction during implant insertion at the posterior and anterior disc regions (CES, 0.58 and 0.14 mm; SS, 1.04 and 0.78 mm, respectively).ConclusionsResults from the three study arms reveal the potential use of expandable spacers. During implant insertion, CESs provided similar stability, required less insertion force, and significantly reduced over-distraction of the annulus compared with SS.

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Section: Discussionsupporting

confidence: 92%

In Vitro Biomechanical and Fluoroscopic Study of a Continuously Expandable Interbody Spacer Concerning Its Role in Insertion Force and Segmental Kinematics

et al. 2018

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“…The pedicle screw fixation treatment is one of the good methods for the clinical treatment of lumbar compression fractures ( 7 ). However, the stability of conventional pedicle screw fixation for patients with osteoporosis is significantly reduced due to lumbar osteoporosis, and it is difficult to achieve a solid internal fixation effect ( 8 ). Expansive pedicle screw can fix the vertical axial section through the front expansive effect ( 9 ), thus forming the triangular support ( 10 ), and significantly increasing the screw bonding ( 11 ); at the same time, the surrounding bone trabecula is appropriately compressed, thereby further improving the bone density and the stability of internal fixation ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

et al. 2018

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Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.

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“…Other authors showed the the safety and efficiency of these implants including intervertebral disc heigh resortation and high fusion rates. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

The double-transforaminal lumbar interbody fusion: an innovative one-stage surgical technique for posterior kyphosis correction

Jäger

Tassemeier

2017

Orthop Rev (Pavia)

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Posttraumatic deformities after vertebral fractures are challenging for orthopedic surgeons in the non-operative and operative field. Especially osteoporotic fractures may cause a hyperkyphosis resulting in segmental or global sagittal imbalance and chronic back pain. Different vertebral osteotomies are potent to restore sagittal profile but show a very high perioperative risk including neurological and soft tissue complications. In addition, some of these extensive operations require a two-step procedure including posterior and anterior approaches. Therefore, these established techniques may be contraindicated in elderly or multimorbide patients suffering from concomitant diseases. The authors describe the double transforaminal lumbar interbody fusion (TLIF) osteotomy (DTO) as an innovative one-stage and low-invasive surgical technique to correct a fixed posttraumatic kyphosis in the thoracolumbar junction. The procedure includes posterior release (laminectomy, facettectomy, nucleotomy) combined with two expandable TLIF implants (sandwich technique) and posterior instrumentation and is illustrated by a case of a multimorbide 78-year old female.

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MIS Expandable Interbody Spacers

Abstract: N/A.

Cited by 24 publications

References 0 publications

In Vitro Biomechanical and Fluoroscopic Study of a Continuously Expandable Interbody Spacer Concerning Its Role in Insertion Force and Segmental Kinematics

In Vitro Biomechanical and Fluoroscopic Study of a Continuously Expandable Interbody Spacer Concerning Its Role in Insertion Force and Segmental Kinematics

Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

The double-transforaminal lumbar interbody fusion: an innovative one-stage surgical technique for posterior kyphosis correction

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