Biomechanical Stability of Lateral Interbody Implants and Supplemental Fixation in a Cadaveric Degenerative Spondylolisthesis Model

Fogel, Guy R.; Turner, Alexander W.; Dooley, Zachary A.; Cornwall, G. Bryan

doi:10.1097/brs.0000000000000485

Cited by 34 publications

(18 citation statements)

References 57 publications

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“…On the other hand, there are several biomechanical studies using cadaveric spine models which compared the stability of the LLIF with or without posterior instrumentation. These studies showed that both the addition of unilateral and bilateral PPS produced a significant decrease in range of motion, compared www.nature.com/scientificreports www.nature.com/scientificreports/ with the standalone cages, in all axes of motion [27][28][29][30] . Finally, they concluded that surgeons should choose fixation options commensurate with the stability requirements of individual patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

Fukushima¹,

Oshima

Tanaka

et al. 2020

Sci Rep

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Lateral lumbar interbody fusion (LLIF) is a widely applied and useful procedure for spinal surgeries. However, posterior fixation has not yet been decided. We compared the radiographic and clinical outcomes of unilateral versus bilateral instrumented one-level LLIF for degenerative lumbar disease. We conducted a prospective cohort study of 100 patients, who underwent unilateral (group U) or bilateral (group B) instrumented one-level LLIF for degenerative lumbar disease. Forty-one patients in group U were undergoing unilateral pedicle screw instrumentation, and 59 patients in group B were undergoing bilateral pedicle screw instrumentation. Clinical characteristic and demographic data before surgery were compared. The intraoperative data, including operative time with changes in positions, intraoperative blood loss, and X-ray exposure time, as well as the perioperative data, including postoperative hospital stay and clinical and radiographic data were compared. As a result, Group U required a significantly shorter operating time than group B. The subsidence grade and fusion rates exhibited no significant differences in the postoperative radiographic evaluation. Group U had better results in clinical assessments than group B. However, group U required more additional surgeries owing to complications.

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Section: Discussionmentioning

confidence: 99%

Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

Fukushima¹,

Oshima

Tanaka

et al. 2020

Sci Rep

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“…Adjunctive unilateral PSF (UPSF), facet screw fixation (FSF), facet wedging, integrated lateral screws, lateral plating, and ISPF have all been studied. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The latter 2 fixation modalities, lateral plating and ISPF, were of particular interest in this study given their synergistic capabilities. While Fogel et al 8,9 and Reis et al 18 have previously assessed LLIF þ ISPF in vitro; plating was traditional independent fixation only.…”

Section: Discussionmentioning

confidence: 99%

“…Given such inherent structural benefits, it has been proposed that extensive and/or invasive posterior fixation could be unnecessary with LLIF. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Accordingly, increased consideration has been given to alternative, less invasive means to achieving stability with the lateral access technique. Two techniques of particular interest have been lateral plating and interspinous process fixation (ISPF).…”

Section: Introductionmentioning

confidence: 99%

“…Two techniques of particular interest have been lateral plating and interspinous process fixation (ISPF). [3][4][5][7][8][9]14,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Lateral plating does not extend the intraoperative footprint as the plate is placed through the same surgical corridor as the interbody cage and provides immediate rigidity to the anterior column in the axial and coronal planes. ISPF requires an additional posterior midline incision at the index level (though less invasive than that required for pedicle screw fixation), provides robust stability in the sagittal plane, and largely preserves the posterior paraspinal structures.…”

Section: Introductionmentioning

confidence: 99%

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An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

DenHaese

Gandhi

Ferry

et al. 2020

Global Spine Journal

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Study Design: In vitro cadaveric biomechanical study. Objective: Biomechanically characterize a novel lateral lumbar interbody fusion (LLIF) implant possessing integrated lateral modular plate fixation (MPF). Methods: A human lumbar cadaveric (n = 7, L1-L4) biomechanical study of segmental range-of-motion stiffness was performed. A ±7.5 Nċm moment was applied in flexion/extension, lateral bending, and axial rotation using a 6 degree-of-freedom kinematics system. Specimens were tested first in an intact state and then following iterative instrumentation (L2/3): (1) LLIF cage only, (2) LLIF + 2-screw MPF, (3) LLIF + 4-screw MPF, (4) LLIF + 4-screw MPF + interspinous process fixation, and (5) LLIF + bilateral pedicle screw fixation. Comparative analysis of range-of-motion outcomes was performed between iterations. Results: Key biomechanical findings: (1) Flexion/extension range-of-motion reduction with LLIF + 4-screw MPF was significantly greater than LLIF + 2-screw MPF ( P < .01). (2) LLIF with 2-screw and 4-screw MPF were comparable to LLIF with bilateral pedicle screw fixation in lateral bending and axial rotation range-of-motion reduction ( P = 1.0). (3) LLIF + 4-screw MPF and supplemental interspinous process fixation range-of-motion reduction was comparable to LLIF + bilateral pedicle screw fixation in all directions ( P ≥ .6). Conclusions: LLIF with 4-screw MPF may provide inherent advantages over traditional 2-screw plating modalities. Furthermore, when coupled with interspinous process fixation, LLIF with MPF is a stable circumferential construct that provides biomechanical utility in all principal motions.

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“…10,11,23 Another pathology-related criterion has been studied in LLIF subsidence: poor bone quality. Similarly to the present study, Tempel et al 18 conducted a case-control study to analyze bone mineral density (BMD) in cases that evolved with subsidence following LLIF.…”

Section: Discussionmentioning

confidence: 99%

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

et al. 2016

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Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%. (93% vs. 18%; p < 0,001); escoliose (31% vs. 12%; p = 0,033); mulheres (79% vs. 38%; p = 0,007); pacientes idosos (média de 57,0 vs. 68,4 anos; p = 0,001 (93% vs. 18%, p <0,001); escoliosis (31% vs. 12%, p = 0,033); mujeres (79% vs. 38%, p = 0,007); ancianos (media de 57,0 a 68,4 años; p = 0,001

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Biomechanical Stability of Lateral Interbody Implants and Supplemental Fixation in a Cadaveric Degenerative Spondylolisthesis Model

Abstract: N/A.

Cited by 34 publications

References 57 publications

Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

An In Vitro Biomechanical Evaluation of a Lateral Lumbar Interbody Fusion Device With Integrated Lateral Modular Plate Fixation

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

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