Biomechanical Analysis of Cortical Versus Pedicle Screw Fixation Stability in TLIF, PLIF, and XLIF Applications

Nomoto, Edward K.; Fogel, Guy R.; Rasouli, Alexandre; Bundy, Justin; Turner, Alexander W.

doi:10.1177/2192568218779991

Cited by 17 publications

(9 citation statements)

References 46 publications

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“…However, for patients with degenerative spinal scoliosis or multilevel lumbar disease, three or even more levels LLIF are necessary to effectively correct spinal deformity and completely decompress neural elements [ 9 , 10 ]. Although, laterally placed cage was associated with superior segmental stability compared with ALIF and TLIF cages, cage subsidence and interbody un-union were usually observed in stand-alone LLIF compared to those with supplemental fixation, especially in multilevel condition [ 11 – 15 ]. The effect of supplemental instrumentation in multilevel LLIF procedure, such as pedicle screw/rod or lateral plate, on reducing immediately postoperative range of motion (ROM), was not elucidated clearly.…”

Section: Introductionmentioning

confidence: 99%

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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Background This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations. Methods Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS). Results Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP. Conclusions The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

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Section: Introductionmentioning

confidence: 99%

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Lai

Chen

et al. 2021

BMC Musculoskelet Disord

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“…Changes in (lumbar) spinal kinematics have been observed following surgical procedures (spondylodesis using different techniques (Nomoto et al. 2019 ), facetectomy (Zeng et al. 2017 ), implantation of disk prothesis (Yue et al.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in (lumbar) spinal kinematics have been observed following surgical procedures (spondylodesis using different techniques (Nomoto et al 2019), facetectomy (Zeng et al 2017), implantation of disk prothesis (Yue et al 2019) or pedicle screw-based dynamic implants (Prud'homme et al 2015)), but do also occur naturally due to degeneration or trauma (Amevo et al 1992) as well as in obese patients (Rodriguez-Martinez et al 2016). In addition, several studies, in vitro and in vivo, have been conducted to analyze lumbar spinal kinematics and to determine the centrode under healthy and degenerative conditions, see (Widmer et al 2019) for a review.…”

Section: Centrodes From a Medical Point Of Viewmentioning

confidence: 99%

Muscle-driven and torque-driven centrodes during modeled flexion of individual lumbar spines are disparate

Rockenfeller

Müller

Damm

et al. 2020

Biomech Model Mechanobiol

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Lumbar spine biomechanics during the forward-bending of the upper body (flexion) are well investigated by both in vivo and in vitro experiments. In both cases, the experimentally observed relative motion of vertebral bodies can be used to calculate the instantaneous center of rotation (ICR). The timely evolution of the ICR, the centrode, is widely utilized for validating computer models and is thought to serve as a criterion for distinguishing healthy and degenerative motion patterns. While in vivo motion can be induced by physiological active structures (muscles), in vitro spinal segments have to be driven by external torque-applying equipment such as spine testers. It is implicitly assumed that muscle-driven and torque-driven centrodes are similar. Here, however, we show that centrodes qualitatively depend on the impetus. Distinction is achieved by introducing confidence regions (ellipses) that comprise centrodes of seven individual multi-body simulation models, performing flexion with and without preload. Muscle-driven centrodes were generally directed superior–anterior and tail-shaped, while torque-driven centrodes were located in a comparably narrow region close to the center of mass of the caudal vertebrae. We thus argue that centrodes resulting from different experimental conditions ought to be compared with caution. Finally, the applicability of our method regarding the analysis of clinical syndromes and the assessment of surgical methods is discussed.

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“…A variety of lateral and posterior xation methods are available to supplement OLIF with varying capabilities to restrict range of motion (ROM) [13,16]. Bilateral pedicle screw (BPS) xation is a common technique that can offer improved biomechanical stability in all directions [17]. BPS is associated with a slight, but signi cant increase in complications due to the risk of screw malpositioning and wound healing problems and is relatively more expensive [18].…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Lang

Sun

Yuan

et al. 2021

Preprint

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Background Oblique lateral interbody fusion (OLIF) is applied often to treat degenerative disc disease in the lumbar spine. Stand-alone OLIF prevents morbidities associated with supplemental fixation and is less expensive. However, it remains controversial whether stand-alone OLIF is sufficient to avoid subsidence for single-level diseases. Additionally, bilateral pedicle screw (BPS) and bilateral transfacet screw (BTS) fixation are well-established posterior fixation methods that can offer improved biomechanical stability. But the comparison of clinical outcomes of OLIF with and without supplementary instrumentation is lack. Methods We retrospectively examined 20 patients who underwent single-level stand-alone OLIF for symptomatic lumbar degenerative disease at L1–L5 (SA group). Groups of patients treated with OLIF plus BPS (n = 20, BPS group) or BTS (n = 20, BTS group) were matched for age, sex, diagnosis, operative level, body mass index, and bone mineral density. The disk height index (DHI), segmental lordotic (SL) angle, and lumbar lordotic (LL) angle were measured preoperatively and at 3 days and 6 months postoperatively. Clinical outcomes were evaluated. Results Significant disc height loss was observed in all groups, but was greater in the SA and BTS groups than in the BPS group at the 6-month follow-up. The SL and LL angles were not affected in any group. The operative time was significantly less in the SA group, and the estimated blood loss was significantly higher in the BPS group. At 6 months post-surgery, improvements in clinical outcomes were evident in all groups, but the VAS (back pain), JOA, and ODI scores were worse in the SA group than in the other groups. Conclusions Stand-alone OLIF was associated with greater subsidence and poorer clinical outcomes compared with OLIF plus supplementary instrumentation. The addition of BTS did not decrease the degree of subsidence, but provided clinical outcomes comparable to those achieved with BPS.

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Biomechanical Analysis of Cortical Versus Pedicle Screw Fixation Stability in TLIF, PLIF, and XLIF Applications

Cited by 17 publications

References 46 publications

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation

Muscle-driven and torque-driven centrodes during modeled flexion of individual lumbar spines are disparate

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

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