In Vitro, Biomechanical Comparison of an Anterior Lumbar Interbody Fusion with an Anteriorly Placed, Low-Profile Lumbar Plate and Posteriorly Placed Pedicle Screws or Translaminar Screws

Beaubien, Brian P.; Derinçek, Alihan; Lew, William D.; Wood, Kirkham B.

doi:10.1097/01.brs.0000174275.95104.12

Cited by 73 publications

(49 citation statements)

References 31 publications

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“…Interbody fusion can be carried out through the anterior or posterior approach. Though high fusion rates have been reported with the anterior approach, the possibility of iliac vessel injury and retrograde ejaculation cannot be overlooked [3,16,17]. Further, studies have recommended that anterior lumbar interbody fusion (ALIF) be supplemented with posterior instrumentation for higher fusion rates [21].…”

Section: Discussionmentioning

confidence: 99%

Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw

2008

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Lumbar spinal fusion is advancing with minimally invasive techniques, bone graft alternatives, and new implants. This has resulted in significant reductions of operative time, duration of hospitalization, and higher success in fusion rates. However, costs have increased as many new technologies are expensive. This study was carried out to investigate the clinical outcomes and fusion rates of a low implant load construct of unilateral pedicle screws and a translaminar screw in transforaminal lumbar interbody fusion (TLIF) which reduced the cost of the posterior implants by almost 50%. Nineteen consecutive patients who underwent single level TLIF with this construct were included in the study. Sixteen patients had a TLIF allograft interbody spacer placed, while in three a polyetheretherketone (PEEK) cage was used. Follow-up ranged from 15 to 54 months with a mean of 32 months. A clinical and radiographic evaluation was carried out preoperatively and at multiple time points following surgery. An overall improvement in Oswestry scores and visual analogue scales for leg and back pain (VAS) was observed. Three patients underwent revision surgery due to recurrence of back pain. All patients showed radiographic evidence of fusion from 9 to 26 months (mean 19) following surgery. This study suggests that unilateral pedicle screws and a contralateral translaminar screw are a cheaper and viable option for single level lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw

2008

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“…1,44 Moreover, a transsacral rod enhanced with pedicle screws has been shown to reduce the range of motion to levels comparable to anterior interbody fusion cages augmented with a similar posterior construct in biomechanical testing. 2,6 However, although the short-term biomechanical stability of the AxiaLIF device combined with posterior instrumentation appears to be solid, the threads of the axial rod may be inadequate to provide long-term structural support. This would be consistent with the findings in the current study; we noticed a transient increase in height of the L5/S1 intervertebral space following implantation of the AxiaLIF device.…”

Section: Discussionmentioning

confidence: 99%

“…1,44 Concurrently, cadaver studies have demonstrated that circumferential instrumentation performed using the AxiaLIF device in combination with posterior fixation provides biomechanical stability similar to anterior interbody fusion cages augmented with a posterior construct. 2,6 Although the paracoccygeal transsacral approach is not without risks and there is a potential for visceral and vascular injuries, 12,39,55 the reported rates of perioperative morbidity are low. 3,5,27,58,59 However, a recent report raised serious concerns regarding the long-term durability of 2-level AxiaLIF constructs.…”

mentioning

confidence: 99%

Radiographic and clinical outcome after 1- and 2-level transsacral axial interbody fusion

Hofstetter¹,

Shin²,

Tsiouris

et al. 2013

SPI

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Object The paracoccygeal approach allows for instrumentation of L5/S1 and L4/5 by using a transsacral rod (AxiaLIF; TransS1, Inc.). The authors analyzed clinical and radiographic outcomes of 1- or 2-level AxiaLIF procedures with focus on durability of the construct. Methods This was a retrospective study of 38 consecutive patients who underwent either 1-level (32 patients) or 2-level (6 patients) AxiaLIF procedures at the authors' institution. The Oswestry Disability Index (minimum clinically important difference [MCID] ≥ 12) and visual analog scale ([VAS]; MCID ≥ 3) scores were collected. Disc height and Cobb angles were measured on pre- and postoperative radiographs. Bony fusion was determined on CT scans or flexion/extension radiographs. Results Implantation of a transsacral rod allowed for intraoperative distraction of the L5/S1 intervertebral space and resulted in increased segmental lordosis postoperatively. At a mean follow-up time of 26.2 ± 2.4 months, however, graft subsidence (1.9 mm) abolished partial correction of segmental lordosis. Moreover, subsidence of the construct reduced L5/S1 lordosis in patients with 1-level AxiaLIF by 3.2° and L4–S1 lordosis in patients with 2-level procedures by 10.1° compared with preoperative values (p < 0.01). Loss of segmental lordosis predicted failure to improve VAS scores for back pain in the patient cohort (p < 0.05). Overall, surgical intervention led to modest symptomatic improvement; only 26.3% of patients achieved an MCID of the Oswestry Disability Index and 50% of patients an MCID of the VAS score for back pain. At last follow-up, 71.9% of L5/S1 levels demonstrated bony fusion (1-level AxiaLIF 80.8%, 2-level AxiaLIF 33.3%; p < 0.05), whereas none of the L4/5 levels in 2-level AxiaLIF fused. Five constructs developed pseudarthrosis and required surgical revision. Conclusions The AxiaLIF procedure constitutes a minimally invasive technique for L5/S1 instrumentation, with low perioperative morbidity. However, the axial rod provides inadequate long-term anterior column support, which leads to subsidence and loss of segmental lordosis. Modification of the transsacral technique to allow for placement of a solid interposition graft may counteract subsidence of the construct.

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“…The advantages to pure moment testing lie in its consistency as an accepted standard protocol across previous literature (Wilke et al, 1998(Wilke et al, , 2001 and its ability to ensure uniform loading across all levels of the spinal column. Among the set-ups currently used to apply pure bending moments (Beaubien et al, 2005;Crawford et al, 1995;DiAngelo et al, 2004;Goel et al, 1988;Kotani et al, 2006;Melcher et al, 2002;Panjabi et al, 2007;Puttlitz et al, 2004;Schwab et al, 2006;Stanley et al, 2004;Wilke et al, 1994), the cable-driven (Acosta et al, 2008;Barnes et al, 2009;Panjabi, 2007) is relatively common due to its minimal requirements and ease of use. This system involves a loading ring attached to one end of the spinal segment and connected to the test frame's actuator head via a cable.…”

Section: Introductionmentioning

confidence: 99%

Pure moment testing for spinal biomechanics applications: Fixed versus 3D floating ring cable-driven test designs

Tang

Ames

Buckley

2012

Journal of Biomechanics

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Pure moment testing has become a standard protocol for in vitro assessment of the effect of surgical techniques or devices on the bending rigidity of the spine. Of the methods used for pure moment testing, cable-driven set-ups are popular due to their low requirements and simple design. Fixed loading rings are traditionally used in conjunction with these cable-driven systems. However, the accuracy and validity of the loading conditions applied with fixed ring designs have raised some concern, and discrepancies have been found between intended and prescribed loading conditions for flexion-extension. This study extends this prior work to include lateral bending and axial torsion, and compares this fixed ring design with a novel "3D floating ring" design. A complete battery of multi-axial bending tests was conducted with both rings in multiple different configurations using an artificial lumbar spine. Applied moments were monitored and recorded by a multi-axial load cell at the base of the specimen. Results indicate that the fixed ring design deviates as much as 77% from intended moments and induces non-trivial shear forces (up to 18 N) when loaded to a non-destructive maximum of 4.5 Nm. The novel 3D floating ring design largely corrects the inherent errors in the fixed ring design by allowing additional directions of unconstrained motion and producing uniform loading conditions along the length of the specimen. In light of the results, it is suggested that the 3D floating ring set-up be used for future pure moment spine biomechanics applications using a cable-driven apparatus.

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In Vitro, Biomechanical Comparison of an Anterior Lumbar Interbody Fusion with an Anteriorly Placed, Low-Profile Lumbar Plate and Posteriorly Placed Pedicle Screws or Translaminar Screws

Abstract: Although not as rigid as pedicle or translaminar screws, anterior lumbar plating does add significant stability to an ALIF and may provide a valuable, single-approach alternative to supplemental posterior fixation.

Cited by 73 publications

References 31 publications

Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw

Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw

Radiographic and clinical outcome after 1- and 2-level transsacral axial interbody fusion

Pure moment testing for spinal biomechanics applications: Fixed versus 3D floating ring cable-driven test designs

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