19 Harley St, London, W1G 9QJ, UK

The effect of polymethylmethacrylate augmentation on the primary stability of stand-alone implant construct versus posterior stabilization in oblique lumbar interbody fusion with osteoporotic bone quality- a finite element study – Lumbar Fusion

Day Case Lumbar Fusion Surgery

This article discusses the use of screw augmentation in oblique lumbar interbody fusion (OLIF) procedures to improve primary stability, particularly in patients with osteoporotic bone quality. The study investigates the biomechanical effect of screw augmentation using computer-aided finite element analysis. A validated finite element model with normal and osteoporotic bone material properties was used, and OLIF implants with bilateral pedicle screws (BPS) and a self-anchoring stand-alone lateral plate system (SSA) were tested. The results show that screw augmentation can enhance the primary stability of the constructs and decrease the difference between them. A specific amount of injected polymethyl methacrylate (PMMA) per screw is suggested for SSA augmentation. The findings highlight the potential biomechanical advantage of augmented OLIF implants and the desirability of an SSA device with PMMA augmentation capability. Further testing is recommended to fully understand these biomechanical aspects

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top day surgery hospital on Harley Street UK

Published article

S: Based on this study, augmentation can enhance the primary stability of the constructs and decrease the difference between them. Considering leakage as a possible complication, between 3 cm³ and 4 cm³ of injected PMMA per screw can be an adequate amount for SSA augmentation. However, further in silico, and possibly in vitro and clinical testing is required to thoroughly understand the investigated biomechanical aspects.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine J. 2024 Jan 31:S1529-9430(24)00039-1. doi: 10.1016/j.spinee.2024.01.021. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Oblique lumbar interbody fusion (OLIF) can provide an ideal minimally invasive solution for achieving spinal fusion in an older, more frail population where decreased bone quality can be a limiting factor. Stabilization can be achieved with bilateral pedicle screws (BPS), which require additional,

Spine J. 2024 Jan 31:S1529-9430(24)00039-1. doi: 10.1016/j.spinee.2024.01.021. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Oblique lumbar interbody fusion (OLIF) can provide an ideal minimally invasive solution for achieving spinal fusion in an older, more frail population where decreased bone quality can be a limiting factor. Stabilization can be achieved with bilateral pedicle screws (BPS), which require additional incisions and longer operative time. Alternatively, a novel self-anchoring stand-alone lateral plate system (SSA) can be used, where no additional incisions are required. Based on the relevant literature, BPS constructs provide greater primary biomechanical stability compared to lateral plate constructs, including SSA. This difference is further increased by osteoporosis. Screw augmentation in spinal fusion surgeries is commonly used; however, in the case of OLIF, it is a fairly new concept, lacking a consensus-based guideline.

PURPOSE: This comparative study aimed to investigate the effect of PMMA screw augmentation on the primary stability of a stand-alone implant construct versus posterior stabilization in oblique lumbar interbody fusion with osteoporotic bone quality.

STUDY DESIGN: The biomechanical effect of screw augmentation was studied inside an in-silico environment using computer-aided finite element analysis.

METHODS: A previously validated and published L2-L4 finite element model with normal and osteoporotic bone material properties was used. Geometries based on the OLIF implants (BPS, SSA) were created and placed inside the L3-L4 motion segment with increasing volumes (1 cm3 – 6 cm3) of PMMA augmentation. A 400 N follower load and 10 Nm bending moment (in the three anatomical planes) were applied to the surgical finite element models with different bone material properties. The operated L3-L4 segmental range of motion (ROM), the inserted cage’s maximal caudal displacements, and L4 cranial bony endplate principal stress values were measured.

RESULTS: The non-augmented values for the BPS construct were generally lower compared to SSA, and the difference was increased by osteoporosis. In osteoporotic bone, PMMA augmentation gradually decreased the investigated values and the difference between the two constructs as well. Between 3 cm3 and 4 cm3of injected PMMA volume per screw, the difference between augmented SSA and standard BPS became comparable.

S: Based on this study, augmentation can enhance the primary stability of the constructs and decrease the difference between them. Considering leakage as a possible complication, between 3 cm3 and 4 cm3 of injected PMMA per screw can be an adequate amount for SSA augmentation. However, further in silico, and possibly in vitro and clinical testing is required to thoroughly understand the investigated biomechanical aspects.

CLINICAL SIGNIFICANCE: This study sheds light on the possible biomechanical advantage offered by augmented OLIF implants and provides a theoretical augmentation amount for the SSA construct. Based on the findings, the concept of an SSA device with PMMA augmentation capability is desirable.

PMID:38307174 | DOI:10.1016/j.spinee.2024.01.021

The London Spine Unit : top day surgery hospital on Harley Street UK

Read the original publication:

The effect of polymethylmethacrylate augmentation on the primary stability of stand-alone implant construct versus posterior stabilization in oblique lumbar interbody fusion with osteoporotic bone quality- a finite element study

Related Posts

0/5 (0 Reviews)

Trusindex Reviews

London Spine Unit Harley Street Hospital

A Focus on High Quality Specialised Care

We are a specialist Private Hospital based on Harley Street, London UK The Harley Street Hospital, Day Surgery Hospital

We provide exclusive health services for individuals seeking Advanced medical, non-surgical or minimally invasive treatments. We are covered by All Insurance Companies apart from AXA PPP

Our Medical Director and Lead Spinal Surgeon Mr Mo Akmal MD is a world renowned Spine Specialist Consultant with over 20 years of experience. He and his team have developed revolutionary techniques to perform all types of Spinal Surgery as a Day Case procedure without traditional General Anaesthetic.

We are constantly improving our techniques for treatment and improving facilities for our patients.

Book your Appointment Now 
Check out our Reviews 
Check out our Patient Videos 
Check our Mr Akmal’s Profile

 

What our patients say ...

Spine J. 2024 Jan 31:S1529-9430(24)00039-1. doi: 10.1016/j.spinee.2024.01.021. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Oblique lumbar interbody fusion (OLIF) can provide an ideal minimally invasive solution for achieving spinal fusion in an older, more frail population where decreased bone quality can be a limiting factor. Stabilization can be achieved with bilateral pedicle screws (BPS), which require additional
Lumbar slipped Disc

Revolutionary Keyhole surgical technique to vaporise bulging discs

Dr Mo Akmal Medical Director
Dr Mo Akmal MD - Lead Spinal Surgeon

Laser Disc Surgery can be performed under local anaesthetic at The Harley Street Hospital.

Initial Consultation

with Consultant Spine Surgeon
£ 250
  • No Waiting Times
  • Top NHS affiliated Consultant
  • Includes Clinical Review and Report
  • Multidisciplinary discussion
  • Review of Previous Scans and Reports

Follow up Consultation

any appointment after initial consultation
£ 180
  • Top NHS affiliated Consultant
  • Includes Clinical Review and Report
  • Multidisciplinary discussion

High Resolution MRI Scan

any Single Region (3.0 Tesla)
£ 600
  • No waiting times
  • Includes Full Radiologist Report
  • Open or Closed MRI scan types
  • Copy of Scan on CD

Website Offer

Pre-Booked Online
£1130
£ 800
  • Initial Consultation
  • MRI Scan (Single Region)
  • Follow Up consultation
  • Same Day One Stop Visit
  • Full Medical and MRI scan Report
  • Copy of scan on CD
Popular

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810