Lumbar interbody fusion: a parametric investigation of a novel cage design with and without posterior instrumentation

Galbusera, Fabio; Schmidt, Hendrik; Wilke, Hans–Joachim

doi:10.1007/s00586-011-2014-0

Cited by 31 publications

(18 citation statements)

References 40 publications

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“…24 Such destabilization in extension has been ascribed to the postoperative absence of structures otherwise active in loading conditions, such as the anterior longitudinal ligament, the anterior portion of the annulus, and the nucleus pulposus. 8 Because inadequate segmental immobilization during bone healing is claimed as the chief mechanical basis for nonfusion, supplemental posterior fixation via pedicle screws or translaminar screw systems has been advocated to bolster stability in extension and rotation. Indeed, such efforts have boosted fusion rates.…”

Section: Discussionmentioning

confidence: 99%

“…8 Similar to bone, this construct prevents uneven load distribution and thus unwanted remodeling, although higher forces applied to the rigid titanium will trigger bone remodeling. A stress riser then develops at the edges of denser bone, carrying the potential for subsidence or fracture.…”

mentioning

confidence: 99%

“…With extension, the vertebral body tends to lift off from the cage body so that most of the stress is born by screws at the stabilization plate junction. 8,25 Lastfogel et al have speculated that a combination of forces on inferior screws may be one of the factors predisposing to failure of this device. 15 In mapping the structural properties of lumbosacral vertebral endplates, Grant et al 9 discovered that lateral margins were stronger than central areas, both anteriorly and posteriorly.…”

mentioning

confidence: 99%

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Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

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Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3–4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3–4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3–4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3–4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

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“…[22][23][24] Moreover, the inherent poor bone stock increases bone-implant failure, decreases screw pull out strength and might predispose to interbody cage subsidence secondary to increased load distribution. 25,26 Spine surgery in patients with decreased bone mineral density has also been shown to be predisposed to pseudoarthrosis, adjacent level degeneration, progressive junctional kyphosis, and compression fractures, all of which might, but not necessarily, necessitate a revision procedure. 20,27 The finding that Medicare insurance status was more strongly associated with revision cervical spine surgery might be a reflection of the older age of Medicare patients and their generally higher comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis in Cervical Spine Surgery

Guzman

Feldman²,

McAnany³

et al. 2016

SPINE

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“…PEEK), carbon fiber, or allograft bone [29,35]. This surgical technique in which one or more of the vertebrae of the spine are united together so that motion no longer occurs between them, can be performed in different spine regions -cervical, thoracic and lumbar -by using several surgical approaches [23,[36][37][38].…”

Section: Chitosan-based Intervertebral Fusion Cagesmentioning

confidence: 99%