Biomechanical Comparison of Instrumented Posterior Lumbar Interbody Fusion With One or Two Cages by Finite Element Analysis

Chiang, Ming-Fu; Zhong, Zheng Cheng; Chen, Chen Sheng; Cheng, Cheng‐Kung; Shih, Shih Liang

doi:10.1097/01.brs.0000232714.72699.8e

Cited by 59 publications

(47 citation statements)

References 41 publications

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“…While the maximum stress is still greater, the results for the single cage model do approach those of coupled cages after long-term placement. Chiang et al [3] and Tsuang et al [4] showed that inserting a single oblique cage had a similar immediate effect to coupled cages and drew a conclusion that single-cage PLIF is a useful alternative to traditional two-cage PLIF. Drawing from all results collected in this study, it can be stated that, because the long-term results between the two models are much more similar than the immediate results after implantation, instrumented PLIF with one cage should be further encouraged in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, this present study did not consider this type of cage placement, but the two placements that were simulated were performed according to the clinical experience and literature [3].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it has been proposed that a single oblique cage may be sufficient to stabilize the spine and achieve a comparable outcome. Chiang et al [3] and Tsuang et al [4] showed that inserting a single oblique cage with PI can reconstruct the tripod system as the intact disc and facet joints, with a similar clinical outcome to using coupled cages. However, the studies detailed above [3,4] only examined the immediate biomechanical impact of fusion, without considering the long-term effect of cage positioning.…”

Section: Introductionmentioning

confidence: 99%

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Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Zhang

et al. 2016

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Zhang

et al. 2016

International Orthopaedics (SICOT)

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“…Recent studies have also reported that range of motion and stress increased when TLIF was done with asymmetrical positioning of a diagonal cage plus unilateral pedicle screw fixation than with symmetrical positioning of the cage during contralateral axial rotation and lateral bending. [4][5][6] Biomechanical weakness and less stability on TLIF itself, unilateral pedicle screw fixation, and asymmetrical positioning of a cage can be causes of postoperative scoliotic change, cage migration, and lower fusion rate of unilateral screw fixation after MIS TLIF.…”

Section: Discussionmentioning

confidence: 99%

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Choi

Park²,

Kim³

et al. 2013

FOC

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Object Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF. Methods This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment. Results The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%). Conclusions Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.

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“…Generally if no neurodefecit, significant number of patients improve with conservative treatment. Its only when this symptoms disable the patient in doing their normal daily routine activities PLIF (surgery) was the final option [11,12,13] . We too in our trial selected patients who underwent conservative treatment and had no improvement and were severely disabled with above symptoms.…”

Section: Discussionmentioning

confidence: 99%

Cage vs autologous bone grafting in PLIF surgery for spine fusion- randomized control trial

Patil¹,

Bhor²,

Ranjan³

et al. 2017

Int. J. Orthop. Sci.

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Introduction: Posterior lumbar interbody fusion (PLIF) is been used increasingly for degenerative lumbar spine disease to achieve a 360 degree fusion. With the advent of newer techniques and instrumentations the results are good. Aim: To study the outcome of PLIF with cages and that with bone graft for degenerative Lumbar spinal canal stenosis. Material and Methods:We did a double blinded randomized controlled trial at single center. All patients who met with our inclusion criteria and operated from 2007 to 2010 were included in our study. The patients were followed up serially for 5 years for the final outcome. Modified Oswestry low back score and final CT scan based interpretations were applied. Results: Totally 101 patients were included in the study of which 53 underwent PLIF with titanium cage and rest 48 underwent PLIF with bone grafting. We found the results of union rates in both the groups were gratifying, but early and better results with fewer complications were in group with titanium cages. Conclusion: We fairly conclude that better and faster fusion rates with good ambulation can be achieved with titanium cages rather than bone grafting in degenerative lumbar spine disease.

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Biomechanical Comparison of Instrumented Posterior Lumbar Interbody Fusion With One or Two Cages by Finite Element Analysis

Cited by 59 publications

References 41 publications

Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Cage vs autologous bone grafting in PLIF surgery for spine fusion- randomized control trial

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