Impact of lumbar instrumented circumferential fusion on the development of adjacent vertebral compression fracture

Yc, Li; Sc, Yang; Hs, Chen; Kao, YH; Yk, Tu

doi:10.1302/0301-620x.97b10.34927

Cited by 26 publications

(21 citation statements)

References 20 publications

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“…A recent systematic review examining the role of IBF in the setting of DLS found that the majority of available studies identified no radiographic or clinical outcome difference between IBF and other surgical treatments [22]. The increased rigidity conferred by the addition of an interbody device may contribute to elevated rates of adjacent segment degeneration (ASD) and compression fracture [23][24][25][26]. However, conflicting data indicate that IBF may instead protect against ASD by generating more segmental lordosis [27].…”

Section: Indications For Interbody Fusionmentioning

confidence: 99%

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Derman

Albert

2017

Curr Rev Musculoskelet Med

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The existing evidence is mixed regarding the indications for and utility of IBF in DLS, but its use in the setting of pre-operative instability is most strongly supported. Anterior (ALIF), lateral (LLIF), posterior (PLIF), transforaminal (TLIF), and axial (AxiaLIF) lumbar IBF approaches have been described. While the current data are limited, TLIF may be a better option than PLIF in DLS due the increased operative morbidity and peri-operative complications observed with the latter. LLIF also appears superior to PLIF in light of improved radiologic outcomes, fewer intra-operative complications, and potentially greater improvements in disability. The data comparing LLIF to TLIF are less conclusive. No studies specifically comparing ALIF or AxiaLIF to other IBF techniques could be identified. Instability may be the strongest indication for IBF in DLS. When IBF is employed, the authors' preferred technique is TLIF with posterior segmental spinal instrumentation. Further research is needed.

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Section: Indications For Interbody Fusionmentioning

confidence: 99%

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Derman

Albert

2017

Curr Rev Musculoskelet Med

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“…The prevention of motion of the surgical segment leads to high stress on the fixation implant, increasing mobility, and intradiscal pressure at adjacent levels 3 . This may result in adjacent segment degeneration and loosening/rupture of the fixation implant [4][5][6][7][8][9] . Non-fusion and dynamic fusion instruments have been designed to prevent adjacent segment disease.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

Qian

Chen

et al. 2020

Orthopaedic Surgery

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Objective This study aimed to investigate the strength of a novel micro‐dynamic pedicle screw by comparing it to the traditional pedicle screw. Methods Forty‐five lumbar vertebrae received a traditional pedicle screw on one side and a micro‐dynamic pedicle screw on the other side as follows (traditional group vs micro‐dynamic group): 15 vertebrae underwent instant pull‐out testing; 15 vertebrae underwent 5000‐cyclic fatigue loading testing; and 15 vertebrae underwent 10,000‐cyclic fatigue loading testing and micro‐computed tomography (micro‐CT) scanning. The peek pull‐out force and normalized peek pull‐out force after instant pull‐out testing, 5000‐cyclic and 10,000‐cyclic fatigue loading testing were recorded to estimate the resistance of two types of screws. Bone mineral density was recorded to investigate the strength of the different screws in osteoporotic patients. And the semidiameter of the screw insertion area on micro‐CT images after fatigue were compared to describe the performance between screw and bone surface. Results The bone mineral density showed a weak correlation with peek pull‐out force (r = 0.252, P = 0.024). The peek pull‐out force of traditional pedicle screw after 10,000‐cyclic fatigue loading were smaller than that of instant pull‐out test in both osteoporotic (P = 0.017) and healthy group (P = 0.029), the peek pull‐out force of micro‐dynamic pedicle screw after 10,000‐cyclic fatigue loading was smaller than that in instant pull‐out test in osteoporotic group (P = 0.033), but no significant difference in healthy group (P = 0.853). The peek pull‐out force in traditional group and micro‐dynamic group underwent instant pull‐out testing (P = 0.485), and pull‐out testing after 5000‐cyclic fatigue loading testing (P = 0.184) did not show significant difference. However, the peek pull‐out force in micro‐dynamic group underwent pull‐test after 10,000‐cyclic fatigue loading testing was significantly greater than that measured in traditional group (P = 0.005). The normalized peek pull‐out force of traditional groups underwent instant pull‐out testing, pull‐out test after 5000‐cyclic and 10,000‐cyclic fatigue loading testing significantly decreased as the number of cycles increased (P < 0.001); meanwhile, the normalized peek pull‐out force of micro‐dynamic groups remained consistent regardless of the number of cycles (P = 0.133). The semidiameter after the fatigue loading test of the traditional screw insertion area was significantly larger than that of the micro‐dynamic screw insertion area (P = 0.013). Conclusion The novel micro‐dynamic pedicle screw provides stronger fixation stability in high‐cyclic fatigue loading and non‐osteoporotic patients versus the traditional pedicle screw, but similar resistance in low‐cycle fatigue testing and osteoporotic group vs the traditional pedicle screw.

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“…In addition, Li et al found that rigid fusion after posterior lumbar interbody fusion increases stress and leads to a greater risk of adjacent VCFs in osteoporotic patients. 31 Pooled data demonstrated a significant difference in the incidence of subsequent VCFs (RD=−0.24, P <0.001): 7.1% in patients receiving a bisphosphonate and 30.6% in controls. Thus, bisphosphonates prevent subsequent VCFs in patients with lumbar fusion.…”

Section: Discussionmentioning

confidence: 89%

The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis

Liu

Zhao

Shen

et al. 2018

DDDT

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PurposeWe conducted a meta-analysis of controlled clinical trials to evaluate the efficacy of bisphosphonates in lumbar fusion.IntroductionBisphosphonates reduce bone resorption and remodeling by osteoclast activity inhibition, inactivation, and apoptosis. However, it remains controversial whether bisphosphonate therapy affects spinal fusion.MethodsWe searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the effects of bisphosphonates on osteoporotic patients after lumbar fusion. Secondary sources were identified from the references of the included literature. Pooled data were analyzed using RevMan 5.1.ResultsSeven studies met the inclusion criteria. There were significant differences in solid intervertebral fusion (RD=0.07, 95% CI: −0.00 to 0.15, P=0.05), subsequent VCFs (RD=−0.21, 95% CI: −0.30 to −0.12, P<0.00001), pedicle screw loosening (RD=−0.17, 95% CI: −0.28 to −0.05, P=0.006), and cage subsidence (RD=−0.25, 95% CI: −0.42 to −0.07, P=0.005) between two groups. No significant differences between two groups were found regarding implant fixation failure (RD=−0.06, 95% CI: −0.22 to 0.10, P=0.48).ConclusionThis meta-analysis showed that bisphosphonates may increase solid intervertebral fusion and decrease subsequent VCFs, pedicle screw loosening, and cage subsidence.

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Impact of lumbar instrumented circumferential fusion on the development of adjacent vertebral compression fracture

Cited by 26 publications

References 20 publications

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Comparison of the Pull‐Out Strength between a Novel Micro‐Dynamic Pedicle Screw and a Traditional Pedicle Screw in Lumbar Spine

The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis

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