Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease

Chioffe, Michael; McCarthy, Michael; Swiatek, Peter R.; Maslak, Joseph P.; Voronov, Leonard I.; Havey, Robert M.; Muriuki, Muturi; Patwardhan, Avinash G.; Patel, Alpesh A.

doi:10.7759/cureus.6208

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…Kretzer et al [ 17 ] reported stand-alone cage significantly decreased ROM in all motion planes in a cadaveric study, and the addition of facet screws or pedicle screws did not show a significant improvement in stability. In a biomechanical study of L3/4 stand-alone lateral interbody fusion above a previous L4-S1 posterolateral fusion, Chioffe et al [ 8 ] reported that the L3/4 intervertebral ROM was significantly reduced by 50% or even more in all motion planes relative to intact condition, and stand-alone LLIF was a biomechanically sound option in treatment of adjacent segment disease without necessitating revision. However, biomechanical studies evaluating multilevel LLIF were particularly limited, with most studies including one level [ 7 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, mostly biomechanical studies evaluating lateral interbody fusion were usually focused on one or two levels [ 4 , 7 , 8 ]. However, for patients with degenerative spinal scoliosis or multilevel lumbar disease, three or even more levels LLIF are necessary to effectively correct spinal deformity and completely decompress neural elements [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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Background This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations. Methods Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS). Results Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP. Conclusions The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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“…The stress of cage-endplate interface is the main factor leading to cage subsidence [ 11 ]. Previous studies [ 19 , 65 , 66 ] supported the placement of cage on the vertebral epiphysis for interbody fusion, which can not only provide immediate postoperative stability, but also better reduce the incidence of cage subsidence. This is also confirmed by the results of the present study, where endplate stress decreases as the axial area of the cage increases.…”

Section: Discussionmentioning

confidence: 99%

Finite element biomechanical analysis of 3D printed intervertebral fusion cage in osteoporotic population

Wu,

Miao,

Chen

et al. 2024

BMC Musculoskelet Disord

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Objective To study the biomechanical characteristics of each tissue structure when using different 3D printing Cage in osteoporotic patients undergoing interbody fusion. Methods A finite element model of the lumbar spine was reconstructed and validated with regarding a range of motion and intervertebral disc pressure from previous in vitro studies. Cage and pedicle screws were implanted and part of the lamina, spinous process, and facet joints were removed in the L4/5 segment of the validated mode to simulate interbody fusion. A 280 N follower load and 7.5 N·m moment were applied to different postoperative models and intact osteoporotic model to simulate lumbar motion. The biomechanical characteristics of different models were evaluated by calculating and analyzing the range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment. Results After rigid fixation, the range of motion of the fixed segment of model A-C decreased significantly, which was much smaller than that of the osteoporotic model. And with the increase of the axial area of the interbody fusion cages, the fixed segment of model A-C tended to be more stable. The range of motion and intradiscal pressure of the spinal models with different interbody fusion cages were higher than those of the complete osteoporosis model, but there was no significant difference between the postoperative models. On the other hand, the L5 upper endplate stress and screw-rod system stress of model A-C show a decreasing trend in different directions of motion. The stress of the endplate is the highest during flexion, which can reach 40.5 MPa (model A). The difference in endplate stress between models A-C was the largest during lateral bending. The endplate stress of models A and B was 150.5% and 140.9% of that of model C, respectively. The stress of the screw-rod system was the highest during lateral bending (model A, 102.0 MPa), which was 108.4%, 102.4%, 110.4%, 114.2% of model B and 158.5%, 110.1%, 115.8%, 125.4% of model C in flexion, extension, lateral bending, and rotation, respectively. Conclusions For people with osteoporosis, no matter what type of cage is used, good immediate stability can be achieved after surgery. Larger cage sizes provide better fixation without significantly increasing ROM and IDP in adjacent segments, which may contribute to the development of ASD. In addition, larger cage sizes can disperse endplate stress and reduce stress concentration, which is of positive significance in preventing cage subsidence after operation. The cage and screw rod system establish a stress conduction pathway on the spine, and a larger cage greatly enhances the stress-bearing capacity of the front column, which can better distribute the stress of the posterior spine structure and the stress borne by the posterior screw rod system, reduce the stress concentration phenomenon of the nail rod system, and avoid exceeding the yield strength of the material, resulting in the risk of future instrument failure.

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“…Kretzer et al [ 37 ] compared the reduction of ROM at L2–3 and L4–5 in 4 conditions—stand-alone LLIF, bilateral pedicle screw fixation, and 2 facet screw systems—and concluded that all instrumentation decreased ROM compared to the intact spine, with no differences detected among the fixation techniques. In a model of adjacent segment disease, Chioffe et al [ 38 ] found in 6 cadaveric specimens that L3–4 stand-alone LLIF decreased adjacent segment motion by 56%. Finally, in a study that highlights the role of cage width, Pimenta et al [ 18 ] found that a stand-alone 26-mm wide cage provided similar stability to bilateral pedicle screws and rods and greater stability than TLIF with bilateral pedicle screws, as well as 18-mm wide LLIF with unilateral pedicle screws.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Multilevel Stand-Alone Lumbar Lateral Interbody Fusion With Posterior Pedicle Screws: An In Vitro Study

et al. 2023

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Objective: Lumbar lateral interbody fusion (LLIF) allows placement of large interbody cages while preserving ligamentous structures important for stability. Multiple clinical and biomechanical studies have demonstrated the feasibility of stand-alone LLIF in single-level fusion. We sought to compare the stability of 4-level stand-alone LLIF utilizing wide (26 mm) cages with bilateral pedicle screw and rod fixation.Methods: Eight human cadaveric specimens of L1–5 were included. Specimens were attached to a universal testing machine (MTS 30/G). Flexion, extension, and lateral bending were attained by applying a 200 N load at a rate of 2 mm/sec. Axial rotation of ± 8° of the specimen was performed at 2°/sec. Three-dimensional specimen motion was recorded using an optical motion-tracking device. Specimens were tested in 4 conditions: (1) intact, (2) bilateral pedicle screws and rods, (3) 26-mm stand-alone LLIF, (4) 26-mm LLIF with bilateral pedicle screws and rods.Results: Compared to the stand-alone LLIF, bilateral pedicle screws and rods had 47% less range of motion in flexion-extension (p < 0.001), 21% less in lateral bending (p < 0.05), and 20% less in axial rotation (p = 0.1). The addition of bilateral posterior instrumentation to the stand-alone LLIF resulted in decreases of all 3 planes of motion: 61% in flexion-extension ( p < 0.001), 57% in lateral bending (p < 0.001), 22% in axial rotation (p = 0.002).Conclusion: Despite the biomechanical advantages associated with the lateral approach and 26 mm wide cages, stand-alone LLIF for 4-level fusion is not equivalent to pedicle screws and rods.

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Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease

Cited by 6 publications

References 23 publications

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Finite element biomechanical analysis of 3D printed intervertebral fusion cage in osteoporotic population

Biomechanical Comparison of Multilevel Stand-Alone Lumbar Lateral Interbody Fusion With Posterior Pedicle Screws: An In Vitro Study

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