Lumbar Intervertebral Spacer With Cement Augmentation of Endplates and Integrated Screws as a Fixation Device in an Osteoporotic Model: An In Vitro Kinematic and Load-to-Failure Study

Abstract

Background: Integrated lateral lumbar interbody fusion (LLIF) devices have been shown to successfully stabilize the spine and avoid complications related to posterior fixation. However, LLIF has increased subsidence risk in osteoporotic patients. Cement augmentation through cannulated pedicle screws enhances pedicle fixation and cageendplate interface yet involves a posterior approach. Lateral application of cement with integrated LLIF fixation has been introduced and requires characterization. The present study set out to evaluate kinematic and load-to-failure properties of a novel cement augmentation technique with an integrated LLIF device, alone and with unilateral pedicle fixation, compared with bilateral pedicle screws and nonintegrated LLIF (BPS þ S). Methods: Twelve specimens (L3-S1) underwent discectomy at L4-L5. Specimens were separated into 3 groups: (1) BPS þ S; (2) polymethyl methacrylate (PMMA) augmentation, integrated LLIF, and unilateral pedicle screws (PMMA þ UPS þ iS); and (3) PMMA and integrated LLIF (PMMA þ iSA) without posterior fixation. Flexion-extension, lateral bending, and axial rotation were applied. A compressive load was applied to L4-L5 segments until failure. An analysis was performed (P , .05). Results: Operative constructs significantly reduced motion relative to intact specimens in all motion planes (P , .05). BPS þ S provided the most stability, reducing motion by 71.6%-86.4%, followed by PMMA þ UPS þ iS (68.1%-79.4%) and PMMA þ iSA (62.9%-81.9%); no significant differences were found (P. .05). PMMA þ UPS þ iS provided the greatest resistance to failure (2290 N), followed by PMMA þ iSA (1970 N) and BPS þ S (1390 N); no significant differences were observed (P. .05). Conclusions: Cement augmentation of vertebral endplates via the lateral approach with integrated LLIF moderately improved cage-endplate strength compared to BPS þ S in an osteoporotic model; unilateral pedicle fixation further improved failure load. Reconstruction before and after application of unilateral pedicle screws and rods was biomechanically equivalent to anteroposterior reconstruction. Overall, initial results suggest that integrated LLIF with cement augmentation may be a viable alternative in the presence of osteoporosis.

Comparison of novel stabilisation device with various stabilisation approaches: A finite element based biomechanical analysis

“…The assigned material properties for all FE models are depicted in Table 1. 5,25,26 The bottom surface of the L3 vertebrae was fully constrained to stop the all possible motion. In addition, an axial compressive load of 400 N was applied with a moment of 10Nm on the superior surface of the L2 vertebrae.…”

“…22,23 Moreover, researchers have also proposed different stabilisation systems to replicate and simulate an actual spinal segment for better treatment solutions. [24][25][26][27][28][29] Accordingly, it is essential to study the range of motion and load study for any fixation device aiming for spinal stability. However, still, clinical experiments and basic science studies are required to validate these ideas and implementation.…”