Biomechanical Effects of Cage Positions and Facet Fixation on Initial Stability of the Anterior Lumbar Interbody Fusion Motion Segment

Hueng, Dueng‐Yuan; Chung, Tzu-Tsao; Chuang, Wen-Hsien; Hsu, Chi-Pin; Chou, Kuan‐Nien; Lin, Shaw‐Tao

doi:10.1097/brs.0000000000000336

Cited by 17 publications

(10 citation statements)

References 23 publications

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“…If a degenerative process results in destabilisation and abnormal spinal motion, different types of surgical fusion can be used to stabilise the spine [ 53 ]. Interbody fusion implants are widely used to restore disc height and support the anterior column [ 54 ]. Spondylotic changes usually do not require surgery (Fig.…”

Section: B-changes: Annulus Fibrosus End Plates and Bone Marrowmentioning

confidence: 99%

ABCs of the degenerative spine

et al. 2018

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Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents.Teaching Points • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury.• Spine degeneration is a biomechanically related continuum of alterations evolving over time.

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Section: B-changes: Annulus Fibrosus End Plates and Bone Marrowmentioning

confidence: 99%

ABCs of the degenerative spine

et al. 2018

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“… 28) Additionally, with the LIF procedures, the biomechanical and biological properties are influenced not only by variations in the technique, the type and position of interbody implants, or the supplemented posterior instrumentation but also by the grade of the deformity, bone quality, and status of the end plate, especially in older patients. 29 , 30) …”

Section: Contribution Of Lif To Gaining Ideal Lumbar Alignmentmentioning

confidence: 99%

Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis

Takahashi

Hanakita

Ohtake

et al. 2016

Neurol. Med. Chir.(Tokyo)

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Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed.

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“…All of them studied the spinal movement showing that PSF provided a higher segment stiffness than stand-alone cages [26, 27], but segment stability was also reported for the last ones. Since the goal of lumbar surgery is not only to stabilise the segment but also to restore the IVD space and maintain the lumbar lordosis, the major concerns regarding surgery complications are segmental instability [28], cage subsidence [4] and cage migration [29]. Furthermore, lumbar fusion has been associated with the risk of adjacent segment disease because it alters the biomechanical environment of the whole spine [30].…”

Section: Introductionmentioning

confidence: 99%

Is there any advantage of using stand-alone cages? A numerical approach

2019

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Background Segment fusion using interbody cages supplemented with pedicle screw fixation is the most common surgery for the treatment of low back pain. However, there is still much controversy regarding the use of cages in a stand-alone fashion. The goal of this work is to numerically compare the influence that each surgery has on lumbar biomechanics. Methods A non-linear FE model of the whole lumbar spine was developed to compare between two types of cages (OLYS and NEOLIF) with and without supplementary fixation. The motion of the whole spine was analysed and the biomechanical environment of the adjacent segments to the operated one was studied. Moreover, the risk of subsidence of the cages was qualitatively evaluated. Results A great ROM reduction occurred when supplementary fixation was used. This stiffening increased the stresses at the adjacent levels. It might be hypothesised that the overloading of these segments could be related with the clinically observed adjacent disc degeneration. Meanwhile, the stand-alone cages allowed for a wider movement, and therefore, the influence of the surgery on adjacent discs was much lower. Regarding the risk of subsidence, the contact pressure magnitude was similar for both intervertebral cage designs and near the value of the maximum tolerable pressure of the endplates. Conclusions A minimally invasive posterior insertion of an intervertebral cage (OLYS or NEOLIF) was compared using a stand-alone design or adding supplementary fixation. The outcomes of these two techniques were compared, and although stand-alone cage may diminish the risk of disease progression to the adjacent discs, the spinal movement in this case could compromise the vertebral fusion and might present a higher risk of cage subsidence. Electronic supplementary material The online version of this article (10.1186/s12938-019-0684-8) contains supplementary material, which is available to authorized users.

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Biomechanical Effects of Cage Positions and Facet Fixation on Initial Stability of the Anterior Lumbar Interbody Fusion Motion Segment

Abstract: N/A.

Cited by 17 publications

References 23 publications

ABCs of the degenerative spine

ABCs of the degenerative spine

Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis

Is there any advantage of using stand-alone cages? A numerical approach

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