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Interspinous-Interbody Fusion via a Strictly Lateral Surgical Approach: A Biomechanical Stabilization Comparison to Constructs Requiring Both Lateral and Posterior Approaches – Lumbar Fusion

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The article discusses the use of a minimally invasive lateral interspinous fixation device for lumbar fusion surgery. Currently, interbody devices used in fusion surgeries require supplemental posterior fixation through a second incision, which can disrupt the supraspinous ligament and necessitate intraoperative repositioning of the patient. The study aimed to compare the stability and maintenance of foraminal distraction provided by the lateral interspinous fixation device with commonly used pedicle screw and facet screw posterior fixation constructs, when combined with lumbar interbody cages. Through biomechanical testing, it was found that the lateral interspinous fixation device effectively stabilized the spine and maintained neuroforaminal distraction similar to the other posterior systems. The results suggest that the lateral interspinous fixation device may offer a favorable alternative to reduce the need for patient repositioning and minimize disruption of native tissues

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative spinal centre in UK

Published article

Objective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the need for intraoperative repositioning and avoid disruption of the supraspinous ligament. The objective of this in…

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Cureus. 2023 Jul 15;15(7):e41918. doi: 10.7759/cureus.41918. eCollection 2023 Jul.ABSTRACTObjective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the,

Cureus. 2023 Jul 15;15(7):e41918. doi: 10.7759/cureus.41918. eCollection 2023 Jul.

ABSTRACT

Objective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the need for intraoperative repositioning and avoid disruption of the supraspinous ligament. The objective of this in vitrobiomechanical study was to investigate segmental multidirectional stability and maintenance of foraminal distraction of a lateral interspinous fixation device compared to commonly used pedicle screw and facet screw posterior fixation constructs when combined with lumbar interbody cages. Methods Six human cadaver lumbar spine specimens were subjected to nondestructive quasistatic loading in the following states: (1) intact; (2) interspinous fixation device alone and (3) with lateral interbody cage; (4) lateral lumbar interbody cage with bilateral pedicle screws; (5) lateral lumbar interbody cage with unilateral pedicle screws; and (6) lateral lumbar interbody cage with facet screws. Multidirectional pure bending in 1.5 Nm increments to 7.5 Nm, and 7.5 Nm flexion-extension bending with a 700 N compressive follower load were performed separately with optoelectronic segmental motion measurement. Relative angular motions of L2-L3, L3-L4, and L4-L5 functional spinal units were evaluated, and the mean instantaneous axis of rotation in the sagittal plane was calculated for the index level. Foraminal height was assessed during combined flexion-extension and compression loading for each test construct. Results All implant configurations significantly restricted flexion-extension motion compared with intact (p < 0.05). No significant differences were found in flexion-extension when comparing the different posterior implants combined with lateral lumbar interbody cages. All posterior fixation devices provided comparable neuroforaminal distraction and maintained distraction during flexion and extension. Conclusions When combinedwith lateral lumbar interbody cages, the minimally invasive lateral interspinous fixation device effectively stabilized the spine and maintained neuroforaminal distraction comparable to pedicle screw constructs or facet screws. These results suggest the lateral interspinous fixation device may provide a favorable alternative to other posterior systems that require patient repositioning during surgery and involve a greater disruption of native tissues.

PMID:37583745 | PMC:PMC10424609 | DOI:10.7759/cureus.41918

The London Spine Unit : innovative spinal centre in UK

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Interspinous-Interbody Fusion via a Strictly Lateral Surgical Approach: A Biomechanical Stabilization Comparison to Constructs Requiring Both Lateral and Posterior Approaches

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Cureus. 2023 Jul 15;15(7):e41918. doi: 10.7759/cureus.41918. eCollection 2023 Jul.ABSTRACTObjective Lumbar fusion performed through lateral approaches is becoming more common. The interbody devices are generally supported by supplemental posterior fixation implanted through a posterior approach, potentially requiring a second incision and intraoperative repositioning of the patient. A minimally invasive lateral interspinous fixation device may eliminate the
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