Interbody cage stabilisation in the lumbar spine: Biomechanical evaluation of cage design, posterior instrumentation and bone density

Lund, Teija; Oxland, Thomas R.; Jost, Bernhard; Cripton, Peter A.; Grassmann, S.; Etter, C.; Nolte, L.-P.

doi:10.1302/0301-620x.80b2.7693

Cited by 219 publications

(169 citation statements)

References 18 publications

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“…PLIF cages supplemented with pedicle screw fixation have shown better reductions in both NZ [47] and ROM [20] when compared to stand-alone PLIF cages, suggesting decreased osteoligamentous injury/rupture strains and decreased cage micromotion. Furthermore, ALIF cages combined with either translaminar [38] or transarticular [49] fixation have also shown reduced ROM compared to stand-alone ALIF cages.…”

Section: Cage Design Characteristicsmentioning

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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Section: Cage Design Characteristicsmentioning

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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“…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]. 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].…”

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%

“…However, this tension band effect decreases gradually along with the interbody fusion, which is a concomitant multi-factorial process: the bone creeping substitution [17], the cage settling into the vertebral endplates due to the repetitive load [6], the loosening of the tension of the annulus fibers due to the viscoelastic property [6], the bone density change [5,9], etc. Generally, bony fusion may occur if stability is maintained [11,12,17], whereas loss of stability before the fusion will probably lengthen the fusion process or result in non-union.…”

Section: Introductionmentioning

confidence: 99%

“…Generally, bony fusion may occur if stability is maintained [11,12,17], whereas loss of stability before the fusion will probably lengthen the fusion process or result in non-union. Many authors have suggested the utilization of supplementary fixations to reinforce the stability, especially in extension [9,14,15]. So far, no study has been performed to investigate the stabilizing effect of laterally inserted cages combined with a supplementary fixation.…”

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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Human Spine, Biomechanics of

Goel

Biyani

Ferrara

et al. 2006

Encyclopedia of Medical Devices and Instrumentation

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The basic anatomy of the human spine is described to highlight the interaction among spinal components that provides the desired function in a normal person. The factors that lead to instability–abnormal motion are described. Abnormal motion may be due to external environmental factors to which the spine is subjected to during activities of daily living (e.g., impact, repetitive loading, lifting) degeneration, infectious diseases, injury or trauma, disorders, and/or surgery. The biomechanics encompasses the mechanical aspects of conservative treatments, surgical procedures and spinal stabilization techniques. These issues are narrated in this article. However, the field of spinal biomechanics is very broad and it is not practical to cover all aspects in one article. For example, this article does not deal with whiplash mechanisms, impact loads, injury biomechnaics due to falls, and in sports to name a few.

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Interbody cage stabilisation in the lumbar spine: Biomechanical evaluation of cage design, posterior instrumentation and bone density

Cited by 219 publications

References 18 publications

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

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

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

Human Spine, Biomechanics of

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