Biomechanical analysis of lateral interbody fusion strategies for adjacent segment degeneration in the lumbar spine.

Autor: Metzger MF; Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Davis Building Rm 6006, Los Angeles, CA 90048, USA. Electronic address: Melodie.Metzger@cshs.org., Robinson ST; Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Davis Building Rm 6006, Los Angeles, CA 90048, USA., Maldonado RC; Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Davis Building Rm 6006, Los Angeles, CA 90048, USA., Rawlinson J; Medtronic Spinal Applied Research, Medtronic Spine, 2600 Sofamor Danek Dr, Memphis, TN 38132., Liu J; Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Suite 3800, Los Angeles, CA 90033, USA., Acosta FL; Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Suite 3800, Los Angeles, CA 90033, USA.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2017 Jul; Vol. 17 (7), pp. 1004-1011. Date of Electronic Publication: 2017 Mar 18.
DOI: 10.1016/j.spinee.2017.03.005
Abstrakt: Background Context: Surgical treatment of symptomatic adjacent segment disease (ASD) typically involves extension of previous instrumentation to include the newly affected level(s). Disruption of the incision site can present challenges and increases the risk of complication. Lateral-based interbody fusion techniques may provide a viable surgical alternative that avoids these risks. This study is the first to analyze the biomechanical effect of adding a lateral-based construct to an existing fusion.
Purpose: The study aimed to determine whether a minimally invasive lateral interbody device, with and without supplemental instrumentation, can effectively stabilize the rostral segment adjacent to a two-level fusion when compared with a traditional posterior revision approach.
Study Design/setting: This is a cadaveric biomechanical study of lateral-based interbody strategies as add-on techniques to an existing fusion for the treatment of ASD.
Methods: Twelve lumbosacral specimens were non-destructively loaded in flexion, extension, lateral bending, and torsion. Sequentially, the tested conditions were intact, two-level transforaminal lumbar interbody fusion (TLIF) (L3-L5), followed by lateral lumbar interbody fusion procedures at L2-L3 including interbody alone, a supplemental lateral plate, a supplemental spinous process plate, and then either cortical screw or pedicle screw fixation. A three-level TLIF was the final instrumented condition. In all conditions, three-dimensional kinematics were tracked and range of motion (ROM) was calculated for comparisons. Institutional funds (<$50,000) in support of this work were provided by Medtronic Spine.
Results: The addition of a lateral interbody device superadjacent to a two-level fusion significantly reduced motion in flexion, extension, and lateral bending (p<.05). Supplementing with a lateral plate further reduced ROM during lateral bending and torsion, whereas a spinous process plate further reduced ROM during flexion and extension. The addition of posterior cortical screws provided the most stable lateral lumbar interbody fusion construct, demonstrating ROM comparable with a traditional three-level TLIF.
Conclusions: The data presented suggest that a lateral-based interbody fusion supplemented with additional minimally invasive instrumentation may provide comparable stability with a traditional posterior revision approach without removal of the existing two-level rod in an ASD revision scenario.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: