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Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease
Study design Biomechanical cadaveric study Objective To compare biomechanical properties of a single stand-alone interbody fusion and a single-level pedicle screw construct above a previous lumbar pedicle fusion. Summary of background data Adjacent segment disease (ASD) is spondylosis of adjacent v...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925380/ https://www.ncbi.nlm.nih.gov/pubmed/31890409 http://dx.doi.org/10.7759/cureus.6208 |
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author | Chioffe, Michael McCarthy, Michael Swiatek, Peter R Maslak, Joseph P Voronov, Leonard I Havey, Robert M Muriuki, Muturi Patwardhan, Avinash Patel, Alpesh A |
author_facet | Chioffe, Michael McCarthy, Michael Swiatek, Peter R Maslak, Joseph P Voronov, Leonard I Havey, Robert M Muriuki, Muturi Patwardhan, Avinash Patel, Alpesh A |
author_sort | Chioffe, Michael |
collection | PubMed |
description | Study design Biomechanical cadaveric study Objective To compare biomechanical properties of a single stand-alone interbody fusion and a single-level pedicle screw construct above a previous lumbar pedicle fusion. Summary of background data Adjacent segment disease (ASD) is spondylosis of adjacent vertebral segments after previous spinal fusion. Despite the consensus that ASD is clinically significant, the surgical treatment of ASD is controversial. Methods Lateral lumbar interbody fusion (LLIF) and posterior spinal fusion (PSF) with pedicle screws were analyzed within a validated cadaveric lumbar fusion model. L3-4 vertebral segment motion was analyzed within the following simulations: without implants (intact), L3-4 LLIF-only, L3-4 LLIF with previous L4-S1 PSF, L3-4 PSF with previous L4-S1 PSF, and L4-S1 PSF alone. L3-4 motion values were measured during flexion/extension with and without axial load, side bending, and axial rotation. Results L3-4 motion in the intact model was found to be 4.7 ± 1.2 degrees. L3-4 LLIF-only decreased motion to 1.9 ± 1.1 degrees. L3-4 LLIF with previous L4-S1 fusion demonstrated less motion in all planes with and without loading (p < 0.05) compared to an intact spine. However, L3-4 motion with flexion/extension and lateral bending was noted to be greater compared to the L3-S1 construct (p < 0.5). The L3-S1 PSF construct decreased motion to less than 1° in all planes of motion with or without loading (p < 0.05). The L3-4 PSF with previous L4-S1 PSF constructs decreased the flexion/extension motion by 92.4% compared to the intact spine, whereas the L3-4 LLIF with previous L4-S1 PSF constructs decreased motion by 61.2%. Conclusions Stand-alone LLIF above a previous posterolateral fusion significantly decreases motion at the adjacent segment, demonstrating its utility in treating ASD without necessitating revision. The stand-alone LLIF is a biomechanically sound option in the treatment of ASD and is advantageous in patient populations who may benefit from less invasive surgical options. |
format | Online Article Text |
id | pubmed-6925380 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-69253802019-12-30 Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease Chioffe, Michael McCarthy, Michael Swiatek, Peter R Maslak, Joseph P Voronov, Leonard I Havey, Robert M Muriuki, Muturi Patwardhan, Avinash Patel, Alpesh A Cureus Orthopedics Study design Biomechanical cadaveric study Objective To compare biomechanical properties of a single stand-alone interbody fusion and a single-level pedicle screw construct above a previous lumbar pedicle fusion. Summary of background data Adjacent segment disease (ASD) is spondylosis of adjacent vertebral segments after previous spinal fusion. Despite the consensus that ASD is clinically significant, the surgical treatment of ASD is controversial. Methods Lateral lumbar interbody fusion (LLIF) and posterior spinal fusion (PSF) with pedicle screws were analyzed within a validated cadaveric lumbar fusion model. L3-4 vertebral segment motion was analyzed within the following simulations: without implants (intact), L3-4 LLIF-only, L3-4 LLIF with previous L4-S1 PSF, L3-4 PSF with previous L4-S1 PSF, and L4-S1 PSF alone. L3-4 motion values were measured during flexion/extension with and without axial load, side bending, and axial rotation. Results L3-4 motion in the intact model was found to be 4.7 ± 1.2 degrees. L3-4 LLIF-only decreased motion to 1.9 ± 1.1 degrees. L3-4 LLIF with previous L4-S1 fusion demonstrated less motion in all planes with and without loading (p < 0.05) compared to an intact spine. However, L3-4 motion with flexion/extension and lateral bending was noted to be greater compared to the L3-S1 construct (p < 0.5). The L3-S1 PSF construct decreased motion to less than 1° in all planes of motion with or without loading (p < 0.05). The L3-4 PSF with previous L4-S1 PSF constructs decreased the flexion/extension motion by 92.4% compared to the intact spine, whereas the L3-4 LLIF with previous L4-S1 PSF constructs decreased motion by 61.2%. Conclusions Stand-alone LLIF above a previous posterolateral fusion significantly decreases motion at the adjacent segment, demonstrating its utility in treating ASD without necessitating revision. The stand-alone LLIF is a biomechanically sound option in the treatment of ASD and is advantageous in patient populations who may benefit from less invasive surgical options. Cureus 2019-11-20 /pmc/articles/PMC6925380/ /pubmed/31890409 http://dx.doi.org/10.7759/cureus.6208 Text en Copyright © 2019, Chioffe et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Orthopedics Chioffe, Michael McCarthy, Michael Swiatek, Peter R Maslak, Joseph P Voronov, Leonard I Havey, Robert M Muriuki, Muturi Patwardhan, Avinash Patel, Alpesh A Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title | Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title_full | Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title_fullStr | Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title_full_unstemmed | Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title_short | Biomechanical Analysis of Stand-alone Lateral Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease |
title_sort | biomechanical analysis of stand-alone lateral lumbar interbody fusion for lumbar adjacent segment disease |
topic | Orthopedics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925380/ https://www.ncbi.nlm.nih.gov/pubmed/31890409 http://dx.doi.org/10.7759/cureus.6208 |
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