Biomechanical evaluation of lateral interbody fusion methods for adjoining section degeneration within the lumbar backbone.
Backbone J. 2017 Jul;17(7):1004-1011
Authors: Metzger MF, Robinson ST, Maldonado RC, Rawlinson J, Liu J, Acosta FL
BACKGROUND CONTEXT: Surgical therapy of symptomatic adjoining section illness (ASD) sometimes entails extension of earlier instrumentation to incorporate the newly affected degree(s). Disruption of the incision website can current challenges and will increase the danger of complication. Lateral-based interbody fusion strategies might present a viable surgical different that avoids these dangers. This research is the primary to investigate the biomechanical impact of including a lateral-based assemble to an current fusion.
PURPOSE: The research aimed to find out whether or not a minimally invasive lateral interbody system, with and with out supplemental instrumentation, can successfully stabilize the rostral section adjoining to a two-level fusion compared with a conventional posterior revision strategy.
STUDY DESIGN/SETTING: This can be a cadaveric biomechanical research of lateral-based interbody methods as add-on strategies to an current fusion for the therapy of ASD.
METHODS: Twelve lumbosacral specimens had been non-destructively loaded in flexion, extension, lateral bending, and torsion. Sequentially, the examined situations had been intact, two-level transforaminal lumbar interbody fusion (TLIF) (L3-L5), adopted by lateral lumbar interbody fusion procedures at L2-L3 together with interbody alone, a supplemental lateral plate, a supplemental spinous course of plate, after which both cortical screw or pedicle screw fixation. A 3-level TLIF was the ultimate instrumented situation. In all situations, three-dimensional kinematics had been tracked and vary of movement (ROM) was calculated for comparisons. Institutional funds (<$50,000) in help of this work had been offered by Medtronic Backbone.
RESULTS: The addition of a lateral interbody system superadjacent to a two-level fusion considerably lowered movement in flexion, extension, and lateral bending (p<.05). Supplementing with a lateral plate additional lowered ROM throughout lateral bending and torsion, whereas a spinous course of plate additional lowered ROM throughout flexion and extension. The addition of posterior cortical screws offered probably the most steady lateral lumbar interbody fusion assemble, demonstrating ROM comparable with a conventional three-level TLIF.
CONCLUSIONS: The information introduced recommend lateral-based interbody fusion supplemented with extra minimally invasive instrumentation might present comparable stability with a conventional posterior revision strategy with out removing of the present two-level rod in an ASD revision situation.
PMID: 28323239 [PubMed – indexed for MEDLINE]