Properties of an interspinous fixation device (ISD) in lumbar fusion constructs: a biomechanical study

Techy, Fernando; Mageswaran, Prasath; Colbrunn, Robb; Bonner, Tara; McLain, Robert F.

doi:10.1016/j.spinee.2013.01.042

Cited by 39 publications

(40 citation statements)

References 24 publications

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“…The interbody cages alone were not tested; thus, quantifying the contribution of the BPSS or the ISS to the PLIF condition was based on the differences between the constructs with and without the interbody cages. Sequential testing of the BPSS after ISS removal has been reported in previous biomechanical studies 7,24 and was assumed to have negligible effects in the biomechanical performance of the BPSS in the current investigation since implantation/removal of the ISS only compromised the interspinous ligament; however, this hypothesis was not investigated. The EL estimations were measured under a small number of cycles and did not take fatigue into account.…”

Section: Study Limitationsmentioning

confidence: 91%

“…Similar findings have been reported when comparing interspinous fusion devices with BPSS in transforminal lumbar interbody fusion (TLIF), where both posterior constructs provided equivalent immediate stability in flexion-extension and the TLIF-BPSS condition showed smaller lateral bending and axial rotation ROM. 7,24 One possible explanation for equivalent axial rotation ROM between the PLIF-ISS and the PLIF-BPSS construct, not observed in a TLIF model, may be related to the interbody spacer contribution; the bilateral implantation of posterior cages may provide slightly greater resistance to torsional motion than a single transforaminal cage, which may have allowed the contribution of the ISS to make both the PLIF-ISS and the PLIF-BPSS constructs equivalent in axial rotation. This hypothesis can be also supported by the results of Kettler et al, 8 where axial rotation ROM was smaller (although not significant) in a PLIF construct than in a TLIF construct, using polyetheretherketone cages.…”

Section: Effects On Rommentioning

confidence: 99%

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Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

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Object In this paper the authors evaluate through in vitro biomechanical testing the performance of an interspinous fusion device as a stand-alone device, after lumbar decompression surgery, and as supplemental fixation to expandable cages in a posterior lumbar interbody fusion (PLIF) construct. Methods Nine L3–4 human cadaveric spines were biomechanically tested under the following conditions: 1) intact/control; 2) L3–4 left hemilaminotomy with partial discectomy (injury); 3) interspinous spacer (ISS); 4) bilateral pedicle screw system (BPSS); 5) bilateral hemilaminectomy, discectomy, and expandable posterior interbody cages with ISS (PLIF-ISS); and 6) PLIF-BPSS. Each test consisted of 100 N of axial preload with ± 7.5 Nm of torque in flexion-extension, right/left lateral bending, and right/left axial rotation. Significant changes in range of motion (ROM), neutral zone stiffness (NZS), elastic zone stiffness (EZS), and energy loss (EL) were explored among conditions using nonparametric Friedman test and Wilcoxon signed-rank comparisons (p ≤ 0.05). Results The injury increased ROM in flexion (p = 0.01), left bending (p = 0.03), and right/left rotation (p < 0.01) and also decreased NZS in flexion (p = 0.01) and extension (p < 0.01). Both the ISS and BPSS reduced flexion-extension ROM and increased flexion-extension stiffness (NZS and EZS) with respect to the injury and intact conditions (p < 0.05), but the ISS condition provided greater resistance than BPSS in extension for ROM, NZS, and EZS (p < 0.01). The BPSS increased the rigidity (ROM, NZS, and EZS) of the intact model in lateral bending and axial rotation (p ≤ 0.01), except in EZS for left rotation (p = 0.23, Friedman test). The incorporation of posterior cages marginally increased (p = 0.05) the EZS of the BPSS construct in flexion but these interbody devices provided significant stability to the ISS construct in lateral bending and axial rotation for ROM (p = 0.02), in lateral bending for NZS (p = 0.02), and in flexion/axial rotation for EZS (p ≤ 0.03); however, both PLIF constructs demonstrated equivalent ROM and stiffness (p ≥ 0.16), except in lateral bending where the PLIF-BPSS was more stable (p = 0.02). In terms of EL, the injury increased EL in flexion-extension (p = 0.02), the ISS increased EL for lateral bending and axial rotation (p ≤ 0.03), and the BPSS decreased EL in lateral bending (p = 0.02), with respect to the intact condition. The PLIF-ISS decreased lateral bending EL with respect to the ISS condition (p = 0.02), but not enough to be smaller or, at least, equivalent, to that of the PLIF-BPSS construct (p = 0.02). Conclusions The ISS may be a suitable device to provide immediate flexion-extension balance after a unilateral laminotomy, but the BPSS provides greater immediate stability in lateral bending and axial rotation motions. Both PLIF constructs performed equivalently in flexion-extension and axial rotation, but the PLIF-BPSS construct is more resistant to lateral bending motions. Further biomechanical and clinical evidence is required to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages.

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Section: Study Limitationsmentioning

confidence: 91%

Section: Effects On Rommentioning

confidence: 99%

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

View full text Add to dashboard Cite

show abstract

“…The mounting procedure and robotic test system have been described in detail in previous studies. 28,29,39 For this study, the robot was programmed to apply 3 continuous loading and unloading cycles of applied moment along each primary axis of motion to simulate flexion-extension (FE), lateral bending (LB), and axial rotation (AR). The specimens were preconditioned to eliminate any viscoelastic effects.…”

Section: Methodsmentioning

confidence: 99%

Zero-profile hybrid fusion construct versus 2-level plate fixation to treat adjacent-level disease in the cervical spine

Healy

Sundar

Cardenas³

et al. 2014

SPI

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Object Single-level anterior cervical discectomy and fusion (ACDF) is an established surgical treatment for cervical myelopathy. Within 10 years of undergoing ACDF, 19.2% of patients develop symptomatic adjacent-level degeneration. Performing ACDF adjacent to prior fusion requires exposure and removal of previously placed hardware, which may increase the risk of adverse outcomes. Zero-profile cervical implants combine an interbody spacer with an anterior plate into a single device that does not extend beyond the intervertebral disc space, potentially obviating the need to remove prior hardware. This study compared the biomechanical stability and adjacent-level range of motion (ROM) following placement of a zero-profile device (ZPD) adjacent to a single-level ACDF against a standard 2-level ACDF. Methods In this in vitro biomechanical cadaveric study, multidirectional flexibility testing was performed by a robotic spine system that simulates flexion-extension, lateral bending, and axial rotation by applying a continuous pure moment load. Testing conditions were as follows: 1) intact, 2) C5–6 ACDF, 3) C4–5 ZPD supraadjacent to simulated fusion at C5–6, and 4) 2-level ACDF (C4–6). The sequence of the latter 2 test conditions was randomized. An unconstrained pure moment of 1.5 Nm with a 40-N simulated head weight load was applied to the intact condition first in all 3 planes of motion and then using the hybrid test protocol, overall intact kinematics were replicated subsequently for each surgical test condition. Intersegmental rotations were measured optoelectronically. Mean segmental ROM for operated levels and adjacent levels was recorded and normalized to the intact condition and expressed as a percent change from intact. A repeated-measures ANOVA was used to analyze the ROM between test conditions with a 95% level of significance. Results No statistically significant differences in immediate construct stability were found between construct Patterns 3 and 4, in all planes of motion (p > 0.05). At the operated level, C4–5, the zero-profile construct showed greater decreases in axial rotation (–45% vs –36%) and lateral bending (–55% vs –38%), whereas the 2-level ACDF showed greater decreases in flexion-extension (–40% vs –34%). These differences were marginal and not statistically significant. Adjacent-level motion was nearly equivalent, with minor differences in flexion-extension. Conclusions When treating degeneration adjacent to a single-level ACDF, a zero-profile implant showed stabilizing potential at the operated level statistically similar to that of the standard revision with a 2-level plate. Revision for adjacent-level disease is common, and using a ZPD in this setting should be investigated clinically because it may be a faster, safer alternative.

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“…Some clinical and biomechanical studies have reported that SPIRE™ provided lumbar stability comparable with pedicle screw instrumentation and had several advantages over the pedicle screw fixation (6,(11)(12)(13). This study displayed that the fixation force of SPIRE™ seemed to be weak compared with that of pedicle screw, but acceptable to some patients.…”

Section: A B Cmentioning

confidence: 99%

“…and rod constructs (11,13). However, these studies addressed oppose results in the restriction of lateral bending and axial rotation.…”

mentioning

confidence: 99%

Can interspinous device, spire™, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?

Lee

Hyun²,

Kim

et al. 2015

Turkish Neurosurgery

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Properties of an interspinous fixation device (ISD) in lumbar fusion constructs: a biomechanical study

Cited by 39 publications

References 24 publications

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Zero-profile hybrid fusion construct versus 2-level plate fixation to treat adjacent-level disease in the cervical spine

Can interspinous device, spire™, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?

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Properties of an interspinous fixation device (ISD) in lumbar fusion constructs: a biomechanical study

Cited by 39 publications

References 24 publications

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Zero-profile hybrid fusion construct versus 2-level plate fixation to treat adjacent-level disease in the cervical spine

Can interspinous device, spire&#8482;, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?

Contact Info

Product

Resources

About

Can interspinous device, spire™, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?