Spinal fusion: A combined anterior and supplementary interspinous technique

Abstract

"Standard", noninstrumented, techniques of anterior interbody fusion are frequently followed by nonunion and collapse of the intervertebral space, probably because of persistent rocking movements, particularly in the sagittal plane. Elimination of these theoretical movements by supplementing an anterior interbody fusion with a posterior interspinous H-graft and a cerclage wire was considered to be biomechanically attractive without having the disadvantages associated with posterior instrumentation. In a prospective study a solid fusion was obtained at 16 of 17 operated Ievels, with a mediocre (+ 50%) fusion as the exception. The height of the intervertebral space was increased at the majority of the fused levels. The technique is only applicable where neural arches are intact. The technique proved to be safe, simple, effective and inexpensive.

Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review

“…It is possible that simpler techniques which focus on the extension direction may be a better solution. For example, Fidler [11] described the clinical use of a H-graft between the spinous processes to supplement interbody bone graft, with excellent results. The inevitable question lies in what degree of immediate stabilization is required to create significant bone growth into the cage and eventual fusion.…”

The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion

“…Worse 3 to 6 year results of this particular stand-alone construct have been presented [5] and Nibu [24] advised to avoid extension motions after stand-alone BAK constructs. Experimental data [10,13,19,25,29,37] suggest that stand-alone cage constructs are not stable enough to create a safe environment for fusion to occur. The critical issue here is the stand-alone concept, not the cage itself.…”

“…Additional posterior fixation with TLS or pedicle Fig. 4 Box-stem plot comparing the three cages for ranges of motion in each loading direction and instrumented testing condition screws will solve this problem and increases segmental in vitro stability [10,13,25,29].…”

Titanium mesh cages (TMC) in spine surgery

“…The use of the TMC as a compression-resistant interspinous device revitalizes the well known technique of the posterior H-graft for spine fusion [5]. Translaminar screws in the lumbar spine demonstrate similar stiffness to pedicle screws, except in extension [13].…”