Finite element analysis of lordosis restoration with anterior longitudinal ligament release and lateral hyperlordotic cage placement

Uribe, Juan S.; Harris, Jeffrey E.; Beckman, Joshua; Turner, Alexander W.; Mundis, Gregory M.; Akbarnia, Behrooz A.

doi:10.1007/s00586-015-3872-7

Cited by 43 publications

(35 citation statements)

References 25 publications

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“…With the advent of lateral grafts with 20°-30° of angulation and sectioning of the ALL, 29 however, much more profound focal and regional curvature can be obtained, typically averaging about 50% of the inserted graft angle (10°-17°). 11,14,41,71,73,75 Case series have demonstrated that the procedure can be performed safely, with blood loss ranging from 40 to 150 ml and with a complication rate similar to that observed with standard lateral transpsoas approaches. 11,29,58 This technique does have some limitations, however, as it generally cannot be used in cases of previous posterior fusion without some form of release, and almost never in cases of a previous interbody fusion unless a pseudarthrosis is present.…”

Section: Discussionmentioning

confidence: 99%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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OBJECTIVEPedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20°–30°) interbody cages, with stabilization through standard posterior instrumentation in all cases.METHODSThe authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors’ institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.RESULTSThe PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35° in the PSO group, 31° in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33° in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1° in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.CONCLUSIONSThis is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.

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Section: Discussionmentioning

confidence: 99%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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“…[29][30][31][32][33] Mechanistically, excessive stress secondary to imbalance in the sagittal plane exhausts the posterior spinal muscles, translating to lower back pain. 34,53,54 We propose 3 augmenting strategies for CMIS correction of sagittal balance using hyperlordotic cages: (1) utilizing appropriately angled cages, (2) anterior positioning of the implant in the disc space, and (3) concentrating Table 4. Mean segmental lordosis grouped by lordotic angle of cage.…”

Section: Discussionmentioning

confidence: 99%

“…[29][30][31][32][33] Novel innovations have been introduced to tackle the problem of sagittal alignment. These include anterior column realignment (ACR), [34][35][36][37][38][39][40][41] rod contouring, 42,43 and the utilization of hyperlordotic cages. 34,38 These are designed to maximize the sagittal correction achievable with CMIS techniques while maintaining the many benefits that MIS operations offer.…”

Section: -17mentioning

confidence: 99%

“…Extreme angled lordotic cages, including 20°a nd 30° cages, introduce certain mechanistic challenges by interrupting the natural curvature of the spine, point loading the endplate, and compromising contact between the cage-bone interphase. 34 Moreover, gains in segmental lordosis reach a threshold as higher-level implants are eventually limited by the posterior elements of the vertebrae. Mirroring this point, the 20° cage in our study produced only 18.32°o f lordosis post op.…”

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confidence: 99%

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The Influence of Lordotic cages on creating Sagittal Balance in the CMIS treatment of Adult Spinal Deformity

Anand

Cohen

et al. 2017

Int J Spine Surg

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“…Uribe et al (30), in their 3D model of the spine, resected ALL via a lateral approach and using hyperlordosis cages of 20 and 30 degrees, demonstrated improvement of lordosis of almost 7 and 11 degrees respectively. Deukmedjian et al (31) in their series of 7 patients showed an increase in segmental lordosis of 17 degrees with ALL released and the use of hyperlordosis cages via XLIF approach.…”

Section: Segmental Lordosismentioning

confidence: 99%

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Winder¹,

Gambhir²

2016

J. Spine Surg.

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The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930's, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). More recently, the lateral trans-psoas approach termed extreme, direct or lateral lumbar interbody fusion (XLIF, DLIF, LLIF) is gaining widespread popularity.The aim of this paper is to compare the approaches, advantages and disadvantages of ALIF and XLIF for L4/5 interbody fusion based on relevant literature.

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Finite element analysis of lordosis restoration with anterior longitudinal ligament release and lateral hyperlordotic cage placement

Cited by 43 publications

References 25 publications

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

The Influence of Lordotic cages on creating Sagittal Balance in the CMIS treatment of Adult Spinal Deformity

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

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