Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

Huec, Jean Charles Le; Liu, M; Skalli, Wafa; Josse, L

doi:10.1007/s005860100316

Cited by 34 publications

(14 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, no statement is made in these reports concerning the clinical outcome in these cases [25,28,29]. Le Huec et al, in a biomechanical cadaveric study, documented that supplementation of the ALIF with an anterolateral plate provided significant additional stabilization in all directions [22]. We did not use supplemental plate fixation in our cases; it is possible that this complication could have been avoided if additional anterior plating was used.…”

Section: Discussionmentioning

confidence: 78%

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

et al. 2004

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 78%

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

et al. 2004

View full text Add to dashboard Cite

“…A Friedman test follow by post hoc Wilcoxon signed-rank paired comparisons were explored at a p ≤ 0.05 significance level. 12 Two statistical analyses in all variables were performed to compensate for the unbalanced data:…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

View full text Add to dashboard Cite

Object In this paper the authors evaluate through in vitro biomechanical testing the performance of an interspinous fusion device as a stand-alone device, after lumbar decompression surgery, and as supplemental fixation to expandable cages in a posterior lumbar interbody fusion (PLIF) construct. Methods Nine L3–4 human cadaveric spines were biomechanically tested under the following conditions: 1) intact/control; 2) L3–4 left hemilaminotomy with partial discectomy (injury); 3) interspinous spacer (ISS); 4) bilateral pedicle screw system (BPSS); 5) bilateral hemilaminectomy, discectomy, and expandable posterior interbody cages with ISS (PLIF-ISS); and 6) PLIF-BPSS. Each test consisted of 100 N of axial preload with ± 7.5 Nm of torque in flexion-extension, right/left lateral bending, and right/left axial rotation. Significant changes in range of motion (ROM), neutral zone stiffness (NZS), elastic zone stiffness (EZS), and energy loss (EL) were explored among conditions using nonparametric Friedman test and Wilcoxon signed-rank comparisons (p ≤ 0.05). Results The injury increased ROM in flexion (p = 0.01), left bending (p = 0.03), and right/left rotation (p < 0.01) and also decreased NZS in flexion (p = 0.01) and extension (p < 0.01). Both the ISS and BPSS reduced flexion-extension ROM and increased flexion-extension stiffness (NZS and EZS) with respect to the injury and intact conditions (p < 0.05), but the ISS condition provided greater resistance than BPSS in extension for ROM, NZS, and EZS (p < 0.01). The BPSS increased the rigidity (ROM, NZS, and EZS) of the intact model in lateral bending and axial rotation (p ≤ 0.01), except in EZS for left rotation (p = 0.23, Friedman test). The incorporation of posterior cages marginally increased (p = 0.05) the EZS of the BPSS construct in flexion but these interbody devices provided significant stability to the ISS construct in lateral bending and axial rotation for ROM (p = 0.02), in lateral bending for NZS (p = 0.02), and in flexion/axial rotation for EZS (p ≤ 0.03); however, both PLIF constructs demonstrated equivalent ROM and stiffness (p ≥ 0.16), except in lateral bending where the PLIF-BPSS was more stable (p = 0.02). In terms of EL, the injury increased EL in flexion-extension (p = 0.02), the ISS increased EL for lateral bending and axial rotation (p ≤ 0.03), and the BPSS decreased EL in lateral bending (p = 0.02), with respect to the intact condition. The PLIF-ISS decreased lateral bending EL with respect to the ISS condition (p = 0.02), but not enough to be smaller or, at least, equivalent, to that of the PLIF-BPSS construct (p = 0.02). Conclusions The ISS may be a suitable device to provide immediate flexion-extension balance after a unilateral laminotomy, but the BPSS provides greater immediate stability in lateral bending and axial rotation motions. Both PLIF constructs performed equivalently in flexion-extension and axial rotation, but the PLIF-BPSS construct is more resistant to lateral bending motions. Further biomechanical and clinical evidence is required to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages.

show abstract

“…Le Huec found that a stand-alone cylindrical interbody cage was not inherently stable, and that a lateral plate was required for stability (17). Cylindrical cages are thought to be inherently unstable because of their limited implant-endplate contact area.…”

Section: A B C Dmentioning

confidence: 99%

Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion

Kiely

Bogner

et al. 2017

J. Spine Surg.

View full text Add to dashboard Cite

Background: To assess the clinical outcomes of 44 patients who underwent single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw instrumentation through a paramedian Wiltse approach.Methods: Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative plain radiographs were assessed for subsidence, cage migration, and fusion.Results: Average age of patients at surgery was 60.8±10.6 years (range, 32-79 years), with 15 males and 29 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was used in 32 cases (73%) and 13 posterolateral fusions (30%). Average duration of surgery was 195.2±36.9 minutes (range: 111-295 minutes), with an estimated blood loss of 159.3±90.8 cc (range, 50-500 cc). There were no intra-operative complications.Average length of hospital stay was 4.2±2.5 days (range, 2-13 days). Four patients (9%) experienced neurological deficit, 2 of which resolved by 3-month follow-up and 2 of which improved but did not resolve by final follow-up at 11 and 16 months. There was significant improvement in VAS (P<0.001), ODI (P<0.001), and SF-12 physical component (P<0.001), but not for SF-12 mental component (P=0.053). Patients with minimum 6 months radiographic follow-up demonstrated successful fusion in 90% of cases (35/39), with 2 cases of grade 1 (5%) subsidence of the adjacent cranial vertebra, and no cases higher than grade 0 subsidence of the adjacent caudal vertebra.Conclusions: Unilateral pedicle screw instrumentation following LLIF was associated with significant improvement in clinical outcomes and favorable radiographic outcomes.

show abstract

Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

Cited by 34 publications

References 21 publications

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion

Contact Info

Product

Resources

About