Biomechanical comparison of an interspinous fusion device and bilateral pedicle screw system as additional fixation for lateral lumbar interbody fusion

Doulgeris, James; Aghayev, Kamran; Gonzalez-Blohm, Sabrina A.; Lee, William; Vrionis, Frank D.

doi:10.1016/j.clinbiomech.2014.10.003

Cited by 27 publications

(28 citation statements)

References 22 publications

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“…Greater reductions in AR ROM have been captured in the literature with LLIF þ BPSF (single-level ROM reduction: 15% to 72.1%); although, such values are still comparable to those in this study. [3][4][5][6][7][11][12][13] Not explored in this study, facet fixation has been shown to be advantageous when seeking rigidity in the axial plane, achieving reductions of 26.7% to 81.9%. 3,6,12,13 These trends can be largely attributed to the robust locking of the middle column with facet fixation.…”

Section: Rom Reductionsmentioning

confidence: 99%

An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

DenHaese

Gandhi

Ferry

et al. 2020

Global Spine Journal

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Study Design: In vitro cadaveric biomechanical study. Objective: Biomechanically characterize a novel lateral lumbar interbody fusion (LLIF) implant possessing integrated lateral modular plate fixation (MPF). Methods: A human lumbar cadaveric (n = 7, L1-L4) biomechanical study of segmental range-of-motion stiffness was performed. A ±7.5 Nċm moment was applied in flexion/extension, lateral bending, and axial rotation using a 6 degree-of-freedom kinematics system. Specimens were tested first in an intact state and then following iterative instrumentation (L2/3): (1) LLIF cage only, (2) LLIF + 2-screw MPF, (3) LLIF + 4-screw MPF, (4) LLIF + 4-screw MPF + interspinous process fixation, and (5) LLIF + bilateral pedicle screw fixation. Comparative analysis of range-of-motion outcomes was performed between iterations. Results: Key biomechanical findings: (1) Flexion/extension range-of-motion reduction with LLIF + 4-screw MPF was significantly greater than LLIF + 2-screw MPF ( P < .01). (2) LLIF with 2-screw and 4-screw MPF were comparable to LLIF with bilateral pedicle screw fixation in lateral bending and axial rotation range-of-motion reduction ( P = 1.0). (3) LLIF + 4-screw MPF and supplemental interspinous process fixation range-of-motion reduction was comparable to LLIF + bilateral pedicle screw fixation in all directions ( P ≥ .6). Conclusions: LLIF with 4-screw MPF may provide inherent advantages over traditional 2-screw plating modalities. Furthermore, when coupled with interspinous process fixation, LLIF with MPF is a stable circumferential construct that provides biomechanical utility in all principal motions.

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Section: Rom Reductionsmentioning

confidence: 99%

An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

DenHaese

Gandhi

Ferry

et al. 2020

Global Spine Journal

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“…1,10,11,20,22,27,35,36,41,[43][44][45] To date, biomechanical studies evaluating the performance of LLIF have generally demonstrated improved stability with LLIF compared with other lumbar interbody fusion procedures, improved biomechanical performance with an interbody implant placed using the LLIF approach without supplemental fixation compared with the intact condition, and further significant improvements in LLIF construct stability following the application of supplemental fixation. 2,3,5,12,13,21,31,32 In addition to investigating the biomechanical effects of an interbody implant and an interbody implant supplemented with posterior screw instrumentation placed using the LLIF approach, the current study is one of very few to include both IP and LP supplemental fixation. The current study demonstrates the following outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Few previous biomechanical studies have evaluated the stability of an IP fixation device with or without supplemental fixation following the LLIF approach. Doulgeris et al 12 compared LLIF, LLIF + IP, and LLIF + BPS constructs in L1-2 segments. Their study showed significant ROM reduction with the LLIF + IP construct versus the LLIF construct in flexion-extension and lateral bending, whereas in the current study the addition of the IP to the LLIF construct reduced angular motion only in flexionextension.…”

Section: Discussionmentioning

confidence: 99%

“…Relatively few biomechanical studies have evaluated the stability of an interbody fusion construct with and without additional anterior or posterior instrumentation inserted using this approach. 2,5,12,13,31,32 This study aimed to evaluate the stability of an interbody fusion construct by using the LLIF approach with and without supplemental pedicle screw-rod, anterolateral plate, and/or interspinous plate (IP) instrumentation. We hypothesized that the large footprint of the interbody implant used in the LLIF approach may provide a biomechanical advantage toward creating a favorable, stable environment for bone fusion.…”

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confidence: 99%

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Biomechanical evaluation of lateral lumbar interbody fusion with secondary augmentation

Reis

Reyes²,

Bse

et al. 2016

SPI

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OBJECTIVE Lateral lumbar interbody fusion (LLIF) has emerged as a popular method for lumbar fusion. In this study the authors aimed to quantify the biomechanical stability of an interbody implant inserted using the LLIF approach with and without various supplemental fixation methods, including an interspinous plate (IP). METHODS Seven human cadaveric L2–5 specimens were tested intact and in 6 instrumented conditions. The interbody implant was intended to be used with supplemental fixation. In this study, however, the interbody was also tested without supplemental fixation for a relative comparison of these conditions. The instrumented conditions were as follows: 1) interbody implant without supplemental fixation (LLIF construct); and interbody implant with supplemental fixation performed using 2) unilateral pedicle screws (UPS) and rod (LLIF + UPS construct); 3) bilateral pedicle screws (BPS) and rods (LLIF + BPS construct); 4) lateral screws and lateral plate (LP) (LLIF + LP construct); 5) interbody LP and IP (LLIF + LP + IP construct); and 6) IP (LLIF + IP construct). Nondestructive, nonconstraining torque (7.5 Nm maximum) induced flexion, extension, lateral bending, and axial rotation, whereas 3D specimen range of motion (ROM) was determined optoelectronically. RESULTS The LLIF construct reduced ROM by 67% in flexion, 52% in extension, 51% in lateral bending, and 44% in axial rotation relative to intact specimens (p < 0.001). Adding BPS to the LLIF construct caused ROM to decrease by 91% in flexion, 82% in extension and lateral bending, and 74% in axial rotation compared with intact specimens (p < 0.001), providing the greatest stability among the constructs. Adding UPS to the LLIF construct imparted approximately one-half the stability provided by LLIF + BPS constructs, demonstrating significantly smaller ROM than the LLIF construct in all directions (flexion, p = 0.037; extension, p < 0.001; lateral bending, p = 0.012) except axial rotation (p = 0.07). Compared with the LLIF construct, the LLIF + LP had a significant reduction in lateral bending (p = 0.012), a moderate reduction in axial rotation (p = 0.18), and almost no benefit to stability in flexion-extension (p = 0.86). The LLIF + LP + IP construct provided stability comparable to that of the LLIF + BPS. The LLIF + IP construct provided a significant decrease in ROM compared with that of the LLIF construct alone in flexion and extension (p = 0.002), but not in lateral bending (p = 0.80) and axial rotation (p = 0.24). No significant difference was seen in flexion, extension, or axial rotation between LLIF + BPS and LLIF + IP constructs. CONCLUSIONS The LLIF construct that was tested significantly decreased ROM in all directions of loading, which indicated a measure of inherent stability. The LP significantly improved the stability of the LLIF construct in lateral bending only. Adding an IP device to the LLIF construct significantly improves stability in sagittal plane rotation. The LLIF + LP + IP construct demonstrated stability comparable to that of the gold standard 360° fixation (LLIF + BPS).

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“…They are characterized by lower blood loss, shorter operative time, and less invasiveness. Biomechanical tests have demonstrated that these interspinous fusion stabilizations could provide similar stability to pedicle screws.…”

Section: Introductionmentioning

confidence: 99%

Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws

Huang

et al. 2017

Orthopaedic Surgery

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Biomechanical comparison of an interspinous fusion device and bilateral pedicle screw system as additional fixation for lateral lumbar interbody fusion

Cited by 27 publications

References 22 publications

An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

Biomechanical evaluation of lateral lumbar interbody fusion with secondary augmentation

Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws

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