Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts

Pavlov, Paul W.; Spruit, Maarten; Havinga, M.E.; Anderson, Peter; Limbeek, Jacques van; Jacobs, W. C. H.

doi:10.1007/s005869900115

Cited by 32 publications

(17 citation statements)

References 20 publications

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“…The lack of initial segmental stability of stand-alone anterior lumbar interbody fusion, compared to posterior fusion or circumferential fusion, can clearly be reproduced in human cadaveric studies [22,26], and is increasingly supported by clinical outcomes, which are unfavorable for stand-alone anterior interbody fusion [9,17]. Our histological findings in the sheep model corroborate this conclusion.…”

Section: Discussionsupporting

confidence: 72%

Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery

Steffen

Stoll

Arvinte

et al. 2001

European Spine Journal

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Harvesting autologous bone graft from the iliac crest is associated with considerable secondary morbidity. Bone graft substitutes such as porous ceramics are increasingly used for spinal surgery. This paper presents the results of an animal study in which β-tricalcium phosphate (β-TCP) bone substitutes were used for anterior spinal surgery in sheep and baboons. The presented baboon study also investigated the effect of impregnating the ceramic material with transforming growth factor (TGF). In the first study, using the sheep model, a stand-alone instrumented anterior fusion was performed. The animals were randomized into three treatment groups: autologous bone, β-TCP granules, and sham group. The results were analyzed biomechanically and histologically at three survival intervals: 8, 16 and 32 weeks. An additional animal group was added later, with ceramic pre-filled implants. In the second study, a baboon model was used to assess the osteointegration of a 15-mm-diameter porous β-TCP block into the vertebral body. The experiment was partially motivated by a new surgical procedure proposed for local bone graft harvest. Three treatment groups were used: β-TCP plug, β-TCP plug impregnated with TGF-β3, and a sham group with empty defect. The evaluation for all animals included computer tomograms at 3 and 6 months, as well as histology at 6 months. In the sheep model, the mechanical evaluation failed to demonstrate differences between treatment groups. This was because massive anterior bone bridges formed in almost all the animals, masking the effects of individual treatments. Histologically, β-TCP was shown to be a good osteoconductor. While multiple signs of implant micromotion were documented, pre-filling the cages markedly improved the histological fusion outcomes. In the baboon study, the β-TCP plugs were completely osteointegrated at 6 months. For the group that used ceramic plugs impregnated with TGF-β3, no incremental advantage was seen as a result of this particular application. However, TGF-β3 is a potent growth factor at a very low dose. Not only does it speed up the ceramic material resorption, but it is also responsible for massive regional new bone formation. More experiments are required to better understand the biological effects of this growth factor in relation to bone formation, and to be able to take clinical advantage of them.Keywords Tricalcium phosphate · Bone substitute · Transforming growth factor β · Interbody spinal fusion · Anterior surgery · Sheep · Baboon ORIGINAL ARTICLE Eur Spine J (2001) 10 : S132-S140

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Section: Discussionsupporting

confidence: 72%

Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery

Steffen

Stoll

Arvinte

et al. 2001

European Spine Journal

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“…Intervertebral cages have been a promising advancement in spinal fusion [1,5,17,18,30,31]; nevertheless, the biological and mechanical requirements as well as the criteria for successful fusion are still under discussion [23,25,39]. This study evaluated the influence of cage insertion, cage material, cancellous bone density and spinal loading on the stress distribution in a functional spinal unit.…”

Section: Discussionmentioning

confidence: 99%

“…A large number of cages exist, which are different in design, material and surgical implanting approach. Several clinical follow-up studies have been published, mostly reporting high fusion rates, even though the criteria for success are inconsistent [1,5,17,18,23,25,30,31]. Additionally, there have been reports of mechanical failure, subsidence and migration [23,39,42].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis

et al. 2002

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IntroductionIntervertebral cages in the lumbar spine have been a promising advancement in spinal fusion. The final goal of the procedure is to relieve low back pain, one of today's major and most expensive health care problems. A large number of cages exist, which are different in design, material and surgical implanting approach. Several clinical follow-up studies have been published, mostly reporting high fusion rates, even though the criteria for success are inconsistent [1,5,17,18,23,25,30,31]. Additionally, there have been reports of mechanical failure, subsidence and migration [23,39,42]. The success of a cage insertion, which is regarded as fusion, and thereby stabilisation, of the spine, in addition to the biological factors, may be dependent on other parameters, including material properties of the vertebrae or the cage, geometry of the implant, and the interface between the bone and the cage [23,25,39,43].Hence, experimental and finite element studies have been carried out to investigate the influence of these facAbstract Intervertebral cages in the lumbar spine have been an advancement in spinal fusion to relieve low back pain. Even though initial stability is accepted as a requirement for fusion, there are other factors. The load transfer and its effect on the tissues adjacent to the cage may also play an essential role, which is not easily detectable with experimental tests. In this study the effects of an intervertebral cage insertion on a lumbar functional spinal unit were investigated using finite element analyses. The influences of cage material, cancellous bone density and spinal loading for the stresses in a functional spinal unit were evaluated. Three-dimensional (3D) finite element models of L2-L3 were developed for this purpose. An anterior approach for a monobloc, boxshaped cage was modelled. Models with cage were compared to the corresponding intact ones. The results showed that inserting a cage increased the maximum von Mises stress and changed the load transfer in the adjacent structures. Varying the cage material or the loading conditions had a much smaller influence than varying the cancellous bone density. The denser the cancellous bone, the more the stress was concentrated underneath the cage, while the remaining regions were unloaded. This study showed that the density of the underlying cancellous bone is a more important factor for the biomechanical behaviour of a motion segment stabilized with a cage, and its eventual clinical success, than the cage material or the applied load. Inserting an intervertebral cage markedly changed the load transfer. The altered stress distribution may trigger bone remodelling and explain damage of the underlying vertebrae.

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“…A SynCage filled with the autologous lamina bone graft was introduced into the intervertebral disc space under distraction. Meticulous removal of disc material using long sharp curettes and preservation of the strong vertebral endplates by avoiding the use of mechanical instruments like burrs is recommended to enhance fusion and prevent subsidence of the interbody cage [32,38].…”

Section: Surgical Techniquementioning

confidence: 99%

Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome

Spruit

Pavlov

Leitao

et al. 2002

European Spine Journal

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IntroductionSeveral options for surgical treatment of adult isthmic spondylolisthesis are available. Decompression alone [11], decompression and fusion [13,18, 30,34], and fusion alone [3,7,18, 26,39] have been recommended. Good clinical results have been achieved with posterior fusion alone without instrumentation [18, 22,36], with instrumentation [4,13, 21, 30,34,39,44] as well as with anterior fusion alone [5,6,20, 21,40,41] or with circumferential fusion [40,41]. Circumferential fusion reduces the pseudoarthrosis rate [22,40], and Kim [22] has shown a strong correlation between successful fusion and successful functional outcome. The literature on this subject is, however, confusing, because of differences in patient groups, etiology and the severity of the spondylolisthesis that was treated. The discussion on how to surgically treat adult isthmic spondylolisthesis has not reached any conclusion. In our clinic we treated patients for low-grade, adult isthmic spondylolisthesis with posterior reduction using pedicle screws followed by second-stage anterior lumAbstract The aim of this study was to evaluate the short-term radiological and functional outcome of surgical treatment for symptomatic, lowgrade, adult isthmic spondylolisthesis. Twelve patients underwent a monosegmental fusion for symptomatic spondylolisthesis. Posterior reduction with pedicle screw instrumentation was followed by secondstage anterior interbody fusion with a cage. All patients underwent a decompressive laminectomy. At an average of 2.1 (range 1.4-3.0) years following surgery, all patients completed the Oswestry questionnaire, VAS back pain score and a questionnaire detailing their work status. Radiographs were evaluated for maintenance of reduction and fusion. The patients (nine male, three female; mean age 42, range 22-54 years) had experienced preoperative symptoms for an average of 38 (range 6-96) months. An average preoperative slip of 21% (range 11-36%) was reduced to 7% (range 0-17%). Reduction of slip was maintained at latest followup, at which time the average VAS score was 2.8 (range 0-8) and the average Oswestry score was 13 (range 0-32). All patients achieved a successful fusion. There were no postoperative nerve root deficits. All patients stated that they would be prepared to undergo the same procedure again if required. Seventy-five percent returned to their pre-symptom work status. Our findings suggest that posterior reduction and anterior fusion for low-grade adult isthmic spondylolisthesis may yield good functional short-term results. A high fusion rate and maintenance of reduction with a low complication rate may be expected. Further followup is necessary to evaluate long-term outcome.

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Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts

Cited by 32 publications

References 20 publications

Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery

Porous tricalcium phosphate and transforming growth factor used for anterior spine surgery

Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis

Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome

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