Changes in Neuroforaminal Height with 2 Level Axial Presacral Lumbar Interbody Fusion at L4-S1

BACKGROUND: The objective was to examine the changes in neuroforaminal height at L4-L5 and L5-S1 after insertion and graduated foraminal distraction using the 2 level transsacral implant in a cadaveric model. METHODS: Discectomy and transsacral instrumentation was performed in six fresh human cadavers at L4-S1. The neuroforaminal height was measured at L4-L5 and L5-S1 before and after insertion of the implant and then at each stage of manual distraction. RESULTS: Mean L4-5 neuroforaminal height increased from 18.2 ± 3.1mm to 20.3± 2.9mm (11%) on the left and from 18.8±2.8mm to 20.6± 2.3mm (12%) on the right (P<0.05). Mean L5-S1 neuroforaminal height increased from 15.7±3.0mm to 18.4 ±2.8mm (17%) on the left and from 15.6 ±2.1mm to 18.3 ±1.8mm (17%) on the right (P<0.05). When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver. At least 2 full rotations of the screw driver were achieved in all cadavers. CONCLUSIONS: The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope. During the initial process, manual control of disc space distraction predictably correlated with the increase in the neuroforaminal height to a maximum. However, further research is needed to look at variables affecting disc space pliability, implant subsidence, in vivo application, and clinical benefit of this procedure.