Biomechanical Properties of Threaded Inserts for Lumbar Interbody Spinal Fusion

Tencer, Allan F.; Hampton, David A.; Eddy, Sharon

doi:10.1097/00007632-199511001-00007

Cited by 133 publications

(74 citation statements)

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“…There is a notable variation in the results from in vitro studies regarding stiffness of the FSU [9,13,14,15,20,22]. This is partly explained by the absence of a clear and standard definition of FSU stiffness [16,22].…”

Section: Discussionmentioning

confidence: 99%

“…A main requirement in achieving the fusion is the need to obtain adequate stability and maintain it during a period sufficient for bone consolidation [11,12,17]. Cage insertion provides an immediate segmental stabilization of the spine, by reducing the intervertebral mobility, although the stabilizing effect varies depending on the surgical approach [12,19,20]. Posterior cage insertion reduces the mobility in flexion and in lateral bending, but not in extension or axial rotation [9].…”

Section: Introductionmentioning

confidence: 99%

“…Posterior cage insertion reduces the mobility in flexion and in lateral bending, but not in extension or axial rotation [9]. Anterior cage insertion has a better stabilizing effect in axial rotation and in lateral bending than posterior insertion, but neither provides significant stabilization in extension [9,12,14,20]. Generally, the surgical approach destroys either the anterior or the posterior tension band of the spine [1], which causes destabilization, particularly in extension.…”

Section: Introductionmentioning

confidence: 99%

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Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

et al. 2001

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Many studies have concluded that stand alone cages provide limited stabilization to the spine, and this primary stabilization decreases postoperatively due to various factors. A supplemental fixation may, therefore, be needed to improve the stability. Extensive biomechanical analysis was performed in the present study to further evaluate the stabilization achieved by a laterally inserted cage and the role of an anterior lateral supplemental fixation. Eight human cadaver functional spinal units were subjected sequentially to four different test conditions: (1) intact, (2) instrumented laterally with a long cylindrical threaded cage, (3) the same cage supplemented with a lateral fixation plate, the plate being firmly connected to the cage, and (4) removal of the connection between the plate and the cage. Pure moments were

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

et al. 2001

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“…ALIF cages have demonstrated equivalent initial stability to femoral ring allografts [15] and a significantly better disc space distraction [40] and neuroforaminal clearance [7] than autografts. The stiffness of cylindrical and conical threaded ALIF cage constructs has been compared [46] in a calf model and found to be similar. The compressive strength of ALIF cage constructs was shown not to be affected by either a central cage-endplate contact or a central endplate decortication [45].…”

mentioning

confidence: 99%

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Tsantrizos¹,

Andreou²,

Aebi³

et al. 2000

European Spine Journal

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IntroductionInterbody fusion is preferred over postero-lateral fusion because it warrants a stronger biomechanical construct [12] and higher fusion rate [11]. It favors load transmission via the anterior column, full restoration of disc height and lordosis, annular fiber tensioning and least demands of bone graft volume [12]. A successful interbody construct provides adequate axial support to resist graft subsidence or collapse and reduces the post-operative segmental mobility to permit graft incorporation [30]. As such, the axial compressive strength and relative three-dimensional stability of an interbody construct are biomechanical measures describing the likelihood of a successful bone fusion [5].Anterior lumbar interbody fusion (ALIF) and posterior lumbar interbody fusion (PLIF) are two accepted approaches of grafted interbody fusion, the latter often combined with pedicle instrumentation [11]. The ALIF proceAbstract Anterior lumbar interbody fusion (ALIF) cages are expected to reduce segmental mobility. Current ALIF cages have different designs, suggesting differences in initial stability. The objective of this study was to compare the effect of different stand-alone ALIF cage constructs and cage-related features on initial segmental stability. Human multisegmental specimens were tested intact and with an instrumented L3/4 disc level. Five different ALIF cages (I/F, BAK, TIS, SynCage, and ScrewCage) were tested non-destructively in axial rotation, flexion/extension and lateral bending. A cage 'pull-out' concluded testing. Changes in neutral zone (NZ) and range of motion (ROM) were analyzed. Cage-related measurements normalized to vertebral dimensions were used to predict NZ and ROM. No cage construct managed to reduce NZ. The BAK and TIS cages had the largest NZ increase in flexion/extension and lateral bending, respectively. Cages did reduce ROM in all loading directions. The TIS cage was the least effective in reducing the ROM in lateral bending. Cages with sharp teeth had higher 'pull-out' forces. Antero-posterior and mediolateral cage dimensions, cage height and wedge angle were found to influence initial stability. The performance of stand-alone ALIF cage constructs generally increased the NZ in any loading direction, suggesting potential directions of initial segmental instability that may lead to permanent deformity. Differences between cages in flexion/extension and lateral bending NZ are attributed to the severity of geometrical cage-endplate surface mismatch. Stand-alone cage constructs reduced ROM effectively, but the residual ROM present indicates the presence of micromotion at the cage-endplate interface.

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“…Generally, human motion segments are recommended for the biomechanical stability investigations of vertebral column implants since the pattern of mobility and the size of the segments in animals tend to differ from that of the human spine [7,40,58]. No problems with regards to implant size arose in the study presented through the use of calf lumbar spines in combination with instrumentation designed for human use.…”

Section: Discussionmentioning

confidence: 99%

Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal

et al. 2005

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Biomechanical Properties of Threaded Inserts for Lumbar Interbody Spinal Fusion

Cited by 133 publications

References 0 publications

Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

Lumbar lateral interbody cage with plate augmentation: in vitro biomechanical analysis

Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs

Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal

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