Biomechanical comparison: stability of lateral-approach anterior lumbar interbody fusion and lateral fixation compared with anterior-approach anterior lumbar interbody fusion and posterior fixation in the lower lumbar spine

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Object. The stability of lateral lumbar interbody graft—augmented fusion and supplementary lateral plate fixation in human cadavers has not been determined. The purpose of this study was to investigate the immediate biomechanical stabilities of the following: 1) femoral ring allograft (FRA)—augmented anterior lumbar interbody fusion (ALIF) after left lateral discectomy combined with additional lateral MACS HMA plate and screw fixation; and 2) ALIF combined with posterior transpedicular fixation after anterior discectomy.

Methods. Sixteen human lumbosacral spines were loaded with six modes of motion. The intervertebral motion was measured using a video-based motion-capturing system. The range of motion (ROM) and the neutral zone (NZ) in each loading mode were compared with a maximum of 7.5 Nm.

The ROM values for both stand-alone ALIF approaches were similar to those of the intact spine, whereas NZ measurements were higher in most loading modes. No significant intergroup differences were found. The ROM and NZ values for lateral fixation in all modes were significantly lower than those of intact spine, except when NZ was measured in lateral bending. All ROM and NZ values for transpedicular fixation were significantly lower than those for stand-alone anterior ALIF. Transpedicular fixation conferred better stabilization than lateral fixation in flexion, extension, and lateral bending modes.

Conclusions. Neither approach to stand-alone FRA-augmented ALIF provided sufficient stabilization, but supplementary instrumentation conferred significant stabilization. The MACS HMA plate and screw fixation system, although inferior to posterior transpedicular fixation, provided adequate stability compared with the intact spine and can serve as a sound alternative to supplementary spinal stabilization.

Article Information

Address reprint requests to: Daniel H. Kim, M.D., Department of Neurosurgery, Stanford University Medical Center, Room R-201, Edwards Building, 300 Pasteur Drive, Stanford, California 94305-5327. email: neurokim@stanford.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Anteroposterior and lateral radiographs demonstrating features of ALIF after application of an FRA and two different supplementary fixation systems. A: Stand-alone ALIF resulted in increased intervertebral space and distracted facet joints compared with upper facet joints (arrows). B: Additional lateral fixation with MACS HMA plate/screw instrumentation. C: Additional posterior transpedicular screw fixation with a TiMX system.

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    Graphs. Normalized ROM values (means ± SDs) obtained in spine specimens after lateral and anterior discectomy, lateral and anterior ALIF, and placement of additional instrumentation. *p < 0.05.

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    Normalized NZ values (means ±SDs) obtained in spine specimens after lateral and anterior discectomy, lateral and anterior ALIF, and placement of additional instrumentation. *p < 0.05.

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