Two-piece ALIF cage optimizes the bone–implant interface in a 360° setting

Abstract

Introduction Clinical research has documented that cage subsidence and the loss of balance correction is a significant complication related to spinal fusion. Subsidence is a multifactorial complication, where implant design is one important element. The aim of the study is to compare the rigidity and bone-implant relative motion of segments treated with either a conventional one-piece ALIF cage versus a two-piece ALIF cage, which adapts in situ and permits 7°-21°of lordosis. Methods Seven lumbosacral (L3-S1) human cadaver specimens were tested in a universal spine tester in the intact condition, the specimens instrumented with a twopiece ALIF cage (Statur Ò -L, FBC Device, Denmark) and a one-piece ALIF cage (Pezo TM -A, Ulrich GmbH & Co. KG., Germany), both supplemented with a pedicle screw system using pure moments of ±7.5 Nm in three principal motion directions. For assessment of the bone-implant interface, fluoroscopic videos were captured during motion and 3D motion was measured using an optical motion capturing system. Results Significantly less motion at the implant-endplate interface was found for the two-piece cage (1.0°± 0.6°) in comparison to the one-piece cage (4.2°± 1.7°) in flexion/ extension. No significant differences in segment rigidity were found between the one-piece and two-piece cages in the 360°setup, while both configurations significantly reduced the range of motion compared to the intact condition (p \ 0.05). Conclusion In comparison to the traditional one-piece ALIF cages, the two-piece cage concept reduced the relative motion at the bone-implant interface without compromising stability.

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

“…These designs have demonstrated more robust angular correction in cadavers. 156 Well-designed clinical trials and comparisons of the rapidly developing new designs have not yet been performed. 112…”

Endplate Trauma During Implant Insertion Affects the Expulsion Risk of Anterior Lumbar Interbody Fusion Devices

“…For example, it has been reported that cages with sharp teeth design have greater pull-out forces [9]. In an effort to optimize and evaluate the stability of ALIF cages, several studies have described the biomechanical results of different ALIF cage designs [9][10][11][12]. However, the detailed features of the resistance against static expulsion of ALIF cages are not yet known [13].…”