The Effect of Interbody Cage Positioning on Lumbosacral Vertebral Endplate Failure in Compression

Labrom, Robert D.; Tan, Juay-Seng; Reilly, Christopher W.; Tredwell, Stephen J.; Fisher, Charles G.; Oxland, Thomas R.

doi:10.1097/01.brs.0000181053.38677.c2

Cited by 44 publications

(29 citation statements)

References 18 publications

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“…The strongest region is located postero-laterally, just in front of the pedicles, with more than twice the strength of the central endplate. In addition, another biomechanical study demonstrated that a dorso-lateral placement of interbody cages in combination with a pedicle screw system results in a 20% higher failure loads than a central cage placement, although the results were not statistically significant [17]. Thus, under in vitro settings, a cage placement in the dorsolateral regions seems to have the advantage of minimizing subsidence when compared to a central or ventral cage placement.…”

Section: Discussionmentioning

confidence: 94%

“…To prevent cage migration, the interface between the implant and the vertebral bone must have sufficient strength to resist the large in vivo loading. Biomechanical studies have shown that the strength of this interface varies across the surface of the endplate [11,17]. Anatomical studies have shown that the density and thickness of the vertebral endplate increase towards the periphery.…”

Section: Introductionmentioning

confidence: 99%

“…This concept was proven in cadaver studies. Labrom et al [17] showed that two smaller titanium mesh cages placed postero-laterally in a cadaver spine provided superior construct rigidity in comparison to centrally placed interbody cages.…”

Section: Introductionmentioning

confidence: 99%

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The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

et al. 2009

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In posterior lumbar interbody fusion, cage migrations and lower fusion rates compared to autologous bone graft used in the anterior lumbar interbody fusion procedure are documented. Anatomical and biomechanical data have shown that the cage positioning and cage type seem to play an important role. Therefore, the aim of the present study was to evaluate the impact of cage positioning and cage type on cage migration and fusion. We created a grid system for the endplates to analyze different cage positions. To analyze the influence of the cage type, we compared ''closed'' box titanium cages with ''open'' box titanium cages. This study included 40 patients with 80 implanted cages. After pedicle screw fixation, 23 patients were treated with a ''closed box'' cage and 17 patients with an ''open box'' cage. The follow-up period averaged 25 months. Twenty cages (25%) showed a migration into one vertebral endplate of \3 mm and four cages (5%) showed a migration of C3 mm. Cage migration was highest in the medio-medial position (84.6%), followed by the postero-lateral (42.9%), and the postero-medial (16%) cage position. Closed box cages had a significantly higher migration rate than open box cages, but fusion rates did not differ. In conclusion, cage positioning and cage type influence cage migration. The medio-medial cage position showed the highest migration rate. Regarding the cage type, open box cages seem to be associated with lower migration rates compared to closed box cages. However, the cage type did not influence bone fusion.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

et al. 2009

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“…The initial advice for transforaminal lumbar interbody fusion (TLIF) was to place the intervertebral cage in the middle/posterior third of the disc space [25]. Posterolateral placement within the intervertebral space, where the endplate is thicker [8] and stronger [8,26], has been suggested following a biomechanical study assessing the risk of cage subsidence [14], whereas central placement has shown greater subsidence in a clinical study [15]. With regard to anterior placement, both a cadaveric [27] and a clinical study [28] involving TLIF found no difference in intervertebral lordosis when cages were placed in the anterior half of the disc space.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of normal sagittal alignment has been increasingly recognised in multi-segmental fusions for spinal deformity [1][2][3]. With increasing focus on patient-related outcomes, there is mounting evidence that optimum sagittal alignment in lumbar fusion is associated with improved outcomes across differing pathologies [1,[4][5][6][7][8][9], reduced post-surgical pain [1-3, 5-8, 10-13], reduced adjacent segment degeneration [4,5,7,[9][10][11][12][13][14], and reduced revision rates [1-5, 7, 9-11, 13, 15-18].…”

Section: Introductionmentioning

confidence: 99%

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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Purpose To examine monosegmental lordosis after posterior lumbar interbody fusion (PLIF) surgery and relate lordosis to cage size, shape, and placement. Methods Eighty-three consecutive patients underwent single-level PLIF with paired identical lordotic cages involving a wide decompression and bilateral facetectomies. Cage parameters relating to size (height, lordosis, and length) and placement (expressed as a ratio relative to the length of the inferior vertebral endplate) were recorded. Centre point ratio (CPR) was the distance to the centre of both cages and indicated mean position of both cages. Posterior gap ratio (PGR) was the distance to the most posterior cage and indicated position and cage length indirectly. Relationships between lordosis and cage parameters were explored. Results Mean lordosis increased by 5.98°(SD 6.86°). The cages used varied in length from 20 to 27 mm, in lordosis from 10°to 18°, and in anterior cage height from 10 to 17 mm. The mean cage placement as determined by CPR was 0.54 and by PGR was 0.16. The significant correlations were: both CPR and PGR with lordosis gain at surgery (r = 0.597 and 0.537, respectively, p \ 0.001 both), cage lordosis with the final lordosis (r = 0.234, p \ 0.05), and anterior cage height was negatively correlated with a change in lordosis (r = -0.297, p \ 0.01).Conclusion Cage size, shape, and position, in addition to surgical technique, determine lordosis during PLIF surgery. Anterior placement with sufficient ''clear space'' behind the cages is recommended. In addition, cages should be of moderate height and length, so that they act as an effective pivot for lordosis.

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Lumbar Spine Injury Biomechanics

2014

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The Effect of Interbody Cage Positioning on Lumbosacral Vertebral Endplate Failure in Compression

Cited by 44 publications

References 18 publications

The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Lumbar Spine Injury Biomechanics

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