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Elucidation of the Mechanism of Occasional Anterior Longitudinal Ligament Rupture with Posterior Correction Procedure for Adult Spinal Deformity Using LLIF-Finite Element Analysis of the Impact of the Lordotic Angle of Intervertebral LLIF Cage – Lumbar Fusion

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The article discusses the use of lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD). While LLIF has several advantages, such as providing a minimally invasive approach, the article highlights the issue of occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. The study conducted finite element analysis (FEA) to understand the mechanism of ALL rupture. The results showed that cages with lower lordotic angles had a higher degree of ALL burden and a shifted rotation center compared to cages with higher lordotic angles. The study emphasizes the importance of using LLIF cages with sufficient lordotic angles in ASD correction. Overall, the article sheds light on unresolved issues and provides insights for improving correction surgeries for ASD

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

Background and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic cages were available and ALL rupture was more frequently experienced compared with later periods when more lordotic cages…

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Medicina (Kaunas). 2023 Aug 29;59(9):1569. doi: 10.3390/medicina59091569.ABSTRACTBackground and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic,

Medicina (Kaunas). 2023 Aug 29;59(9):1569. doi: 10.3390/medicina59091569.

ABSTRACT

Background and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic cages were available and ALL rupture was more frequently experienced compared with later periods when more lordotic cages were available. We performed finite element analysis (FEA) regarding the mechanism of ALL rupture during a posterior correction procedure. Methods: A spring (which mimics ALL) was introduced at the location of ALL in the FEA and an LLIF cage with two different lordotic angles, 6 and 12 degrees (6DC/12DC), was employed. To assess the extent of burden on the ALL, the extension length of the spring during the correction procedure was measured and the location of the rotation center was examined. Results: We observed a significantly higher degree of length extension of the spring during the correction procedure in the FEA model with 6DC compared with that of 12DC. We also observed that the location of the rotation center was shifted posteriorly in the FEA model with 6DC compared with that of 12DC. s: It is considered that the posterior and rostral edge of the less lordotic angle cage became a hinge, and the longer lever arm increased the burden on ALL as the principle of leverage. It is important to use an LLIF cage with a sufficient lordotic angle, that is compatible with the degree of posterior osteotomy in ASD correction.

PMID:37763688 | DOI:10.3390/medicina59091569

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Elucidation of the Mechanism of Occasional Anterior Longitudinal Ligament Rupture with Posterior Correction Procedure for Adult Spinal Deformity Using LLIF-Finite Element Analysis of the Impact of the Lordotic Angle of Intervertebral LLIF Cage

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Medicina (Kaunas). 2023 Aug 29;59(9):1569. doi: 10.3390/medicina59091569.ABSTRACTBackground and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic

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