Effect of Supplemental Translaminar Facet Screw Fixation on the Stability of Stand-Alone Anterior Lumbar Interbody Fusion Cages Under Physiologic Compressive Preloads

Abstract

In vivo during activities of daily living, interbody cage constructs are subject to varying compressive preloads due to external loads generated by paraspinal musculature, and our results suggest that the stability created by the cage (reduction in segmental angular motion) is not constant. The cage construct is likely to be least stable in extension during activities that impart low compressive preloads to the lumbar spine. Supplemental translaminar facet screw fixation will enhance stability of the motion segment treated with threaded cages, particularly during conditions of low compressive preloads, the very condition in which the cage alone is least effective in providing stability.

Stand-alone ALIF with integrated intracorporeal anchoring plates in the treatment of degenerative lumbar disc disease: a prospective study on 65 cases

“…Also, the anterior approach avoids posterior muscular damage [4] and neurological injuries [5]. Despite positive results [6], the stability of stand-alone cages has been questioned during the low muscular preloading phases when the cage has been suspected to be less stable [7]. The instability during the bone healing process is hypothesized to be one of the main reasons for pseudarthrosis [8][9][10] and subsidence [3].…”

A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results

“…Simultaneous combined anterior and posterior fusion was first carried out by O'Brien in 1960 [26]. Supplementation with posterior fixation affords greater stability and a more favourable environment for fusion [11,29,31], and is now well established in modern practice with excellent clinical and radiological outcomes. Evidence for the intervertebral disc as the pain generator in low back pain is increasing [2,6,7,9,32], suggesting a need for removal of the disc for successful treatment of discogenic low back pain.…”

Artrodesis circunferencial: Plif más tornillos translaminofacetarios

“…Oxland y Lund 12 en el año 2000 realizan una revisión bibliográ-fica sobre el tema, todas las cajas tienen un buen desempeño en flexión y mal desempeño en extensión, concluyen también que la suplementación posterior tanto con tornillos pediculares como con tornillos tlf mejora la estabilidad en todas direcciones En un estudio biomecánico mas reciente Phillips et al 13 aborda el estudio de las fijaciones con cajas por vía anterior suplementadas con fijación posterior con tornillos trans laminofacetarios.…”