A biomechanical comparison of supplementary posterior translaminar facet and transfacetopedicular screw fixation after anterior lumbar interbody fusion

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Object. Facet screw fixation is the lowest profile lumbar stabilization method. In this study the immediate biomechanical stability provided by the two different types of fixation are compared: translaminar facet screw (TLFS) and transfacetopedicular screw (TFPS) placement after anterior lumbar interbody fusion (ALIF) using a femoral ring allograft. Both facet screw fixation types were also compared with the gold standard, transpedicular screw and rod (TSR) fixation.

Methods. Twenty-four human lumbosacral spines were tested in the following sequence: intact state, after discectomy, after ALIF, and after TLFS, TFPS, or TSR fixation. Intervertebral motions were measured by a video-based motion capture system. The range of motion (ROM) and neutral zone (NZ) were compared for each loading to a maximum of 7.5 Nm.

The ROMs for stand-alone ALIFs were less than but similar to those of the intact spine, but NZs were slightly increased in all modes. The ROMs for both TLFS and TFPS fixation were significantly decreased from those of the intact spine in all modes and those of the stand-alone ALIF in flexion and extension. The TLFS and TFPS fixations significantly reduced NZs to below that of the intact spine in all modes. Compared with NZs for ALIF, both types of fixation revealed significantly lower values, except for TLFS placement in lateral bending and TFPS fixation in lateral bending and rotation. There were no significant differences between TLFS and TFPS fixation. There were also no significant differences among both TLFS and TFPS and TSR fixations, except that TFPS was inferior to TSR in lateral bending.

Conclusions. Stand-alone ALIF may not provide sufficient stability. Both facet fixations produced significant additional stability and both are comparable to TSR fixation. Although TFPS fixation revealed a slightly inferior result, TFPSs can be placed percutaneously with the assistance of fluoroscopic guidance and it makes the posterior facet fixation minimally invasive. Therefore, the TFPS fixation can be considered as a good alternative to TLFS fixation.

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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    Series of x-ray films revealing features of stand-alone ALIF and an FRA with two different facet fixation methods providing supplementary fixation after ALIF. A: Stand-alone ALIF showing increased intervertebral space and distracted facet joints (arrows). B: A TFPS fixation revealing two screws passing from the pars articularis-inferior articular process transition of the superior vertebra, crossing facets, and into the pedicle of the inferior vertebra. C: A TLFS fixation consisting of two bone screws crossing through the lamina and facet joints. D: A TSR fixation.

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    Photograph of the spine loading fixture depicting the different modes of applied motion.

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    Graphs showing the means and SDs of normalized ROM values for spine specimens after discectomy, ALIF, and additional fixation (TLFS and TFPS). Significance differences (p < 0.05) are shown with an asterisk.

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    Graphs showing the means and SDs of normalized NZ values for spine specimens after discectomy, ALIF, and additional fixation (TLFS and TFPS). Significance differences (p < 0.05) are shown with an asterisk.

References

  • 1.

    Barnes BRodts GEMcLaughlin MRet al: Threaded cortical bone dowels for lumbar interbody fusion: over 1-year mean follow up in 28 patients. J Neurosurg (Spine 1) 95:142001Barnes B Rodts GE McLaughlin MR et al: Threaded cortical bone dowels for lumbar interbody fusion: over 1-year mean follow up in 28 patients. J Neurosurg (Spine 1) 95:1–4 2001

    • Search Google Scholar
    • Export Citation
  • 2.

    Boucher HH: A method of spinal fusion. J Bone Joint Surg Br 41:2482591959Boucher HH: A method of spinal fusion. J Bone Joint Surg Br 41:248–259 1959

    • Search Google Scholar
    • Export Citation
  • 3.

    Farfan HFCossette JWRobertson GHet al: The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. J Bone Joint Surg Am 52:4684971970Farfan HF Cossette JW Robertson GH et al: The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. J Bone Joint Surg Am 52:468–497 1970

    • Search Google Scholar
    • Export Citation
  • 4.

    Glazer PAColliou OLotz JCet al: Biomechanical analysis of lumbosacral fixation. Spine 21:121112221996Glazer PA Colliou O Lotz JC et al: Biomechanical analysis of lumbosacral fixation. Spine 21:1211–1222 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Heggeness MHEsses SI: Translaminar facet joint screw fixation for lumbar and lumbosacral fusion. A clinical and biomechanical study. Spine 16:S266S2691991Heggeness MH Esses SI: Translaminar facet joint screw fixation for lumbar and lumbosacral fusion. A clinical and biomechanical study. Spine 16:S266–S269 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Holte DCO'Brien JPRenton P: Anterior lumbar fusion using a hybrid interbody graft. A preliminary radiographic report. Eur Spine J 3:32381994Holte DC O'Brien JP Renton P: Anterior lumbar fusion using a hybrid interbody graft. A preliminary radiographic report. Eur Spine J 3:32–38 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Janssen MELam CBeckham R: Outcomes of allogenic cages in anterior and posterior lumbar interbody fusion. Eur Spine J 10:S158S1682001Janssen ME Lam C Beckham R: Outcomes of allogenic cages in anterior and posterior lumbar interbody fusion. Eur Spine J 10:S158–S168 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Kanayama MCunningham BWHaggerty CJet al: In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices. J Neurosurg (Spine 2) 93:2592652000Kanayama M Cunningham BW Haggerty CJ et al: In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices. J Neurosurg (Spine 2) 93:259–265 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    King D: Internal fixation for lumbosacral fusion. J Bone Joint Surg Am 30:5605651948King D: Internal fixation for lumbosacral fusion. J Bone Joint Surg Am 30:560–565 1948

    • Search Google Scholar
    • Export Citation
  • 10.

    Lavoie SLindsey RWGugala Zet al: Load sharing and kinematics of threaded cages for lumbar interbody fusion. Clin Orthop 408:1741792003Lavoie S Lindsey RW Gugala Z et al: Load sharing and kinematics of threaded cages for lumbar interbody fusion. Clin Orthop 408:174–179 2003

    • Search Google Scholar
    • Export Citation
  • 11.

    Lu JEbraheim NAYeasting RA: Translaminar facet screw placement: an anatomic study. Am J Orthop 27:5505551998Lu J Ebraheim NA Yeasting RA: Translaminar facet screw placement: an anatomic study. Am J Orthop 27:550–555 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Lund TOxland TRJost Bet al: Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg Br 80:3513591998Lund T Oxland TR Jost B et al: Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design posterior instrumentation and bone density. J Bone Joint Surg Br 80:351–359 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    McAfee PC: Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:8598801999McAfee PC: Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    McAfee PCCunningham BWLee GAet al: Revision strategies for salvaging or improving failed cylindrical cages. Spine 24:214721531999McAfee PC Cunningham BW Lee GA et al: Revision strategies for salvaging or improving failed cylindrical cages. Spine 24:2147–2153 1999

    • Search Google Scholar
    • Export Citation
  • 15.

    Nibu KPanjabi MMOxland Tet al: Multidirectional stabilizing potential of BAK interbody spinal fusion system for anterior surgery. J Spinal Disord 10:3573621997Nibu K Panjabi MM Oxland T et al: Multidirectional stabilizing potential of BAK interbody spinal fusion system for anterior surgery. J Spinal Disord 10:357–362 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Oxland TRHoffer ZNydegger Tet al: A comparative biomechanical investigation of anterior lumbar interbody cages: central and bilateral approaches. J Bone Joint Surg Am 82:3833932000Oxland TR Hoffer Z Nydegger T et al: A comparative biomechanical investigation of anterior lumbar interbody cages: central and bilateral approaches. J Bone Joint Surg Am 82:383–393 2000

    • Search Google Scholar
    • Export Citation
  • 17.

    Oxland TRLund T: Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9:S95S1012000Oxland TR Lund T: Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9:S95–S101 2000

    • Search Google Scholar
    • Export Citation
  • 18.

    Pavlov PWSpruit MHavinga Met al: Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts. Eur Spine J 9:2242292000Pavlov PW Spruit M Havinga M et al: Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts. Eur Spine J 9:224–229 2000

    • Search Google Scholar
    • Export Citation
  • 19.

    Pitzen TGeisler FHMatthis Det al: Motion of threaded cages in posterior lumbar interbody fusion. Eur Spine J 9:5715762000Pitzen T Geisler FH Matthis D et al: Motion of threaded cages in posterior lumbar interbody fusion. Eur Spine J 9:571–576 2000

    • Search Google Scholar
    • Export Citation
  • 20.

    Rathonyi GCOxland TRGerich Uet al: The role of supplemental translaminar screws in anterior lumbar interbody fixation: a biomechanical study. Eur Spine J 7:4004071998Rathonyi GC Oxland TR Gerich U et al: The role of supplemental translaminar screws in anterior lumbar interbody fixation: a biomechanical study. Eur Spine J 7:400–407 1998

    • Search Google Scholar
    • Export Citation
  • 21.

    Stonecipher TWright S: Posterior lumbar interbody fusion with facet-screw fixation. Spine 14:4684711989Stonecipher T Wright S: Posterior lumbar interbody fusion with facet-screw fixation. Spine 14:468–471 1989

    • Search Google Scholar
    • Export Citation
  • 22.

    Thalgott JSChin AKAmeriks JAet al: Minimally invasive 360 degrees instrumented lumbar fusion. Eur Spine J 9:S51S562000Thalgott JS Chin AK Ameriks JA et al: Minimally invasive 360 degrees instrumented lumbar fusion. Eur Spine J 9:S51–S56 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Tsantrizos AAndreou AAebi Met al: Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs. Eur Spine J 9:14222000Tsantrizos A Andreou A Aebi M et al: Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs. Eur Spine J 9:14–22 2000

    • Search Google Scholar
    • Export Citation
  • 24.

    van Akkerveeken PF: Anterior lumbar interbody fusion. Acta Orthop Scand Suppl 251:1051071993van Akkerveeken PF: Anterior lumbar interbody fusion. Acta Orthop Scand Suppl 251:105–107 1993

    • Search Google Scholar
    • Export Citation
  • 25.

    Volkman THorton WCHutton WC: Transfacet screws with lumbar interbody reconstruction: biomechanical study of motion segment stiffness. J Spinal Disord 9:4254321996Volkman T Horton WC Hutton WC: Transfacet screws with lumbar interbody reconstruction: biomechanical study of motion segment stiffness. J Spinal Disord 9:425–432 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Yong-Hing KKirkaldy-Willis WH: The three-joint complex in Weinstein JWiesel SW (eds): The Lumbar Spine. Philadelphia: WB Saunders1990 pp 8087Yong-Hing K Kirkaldy-Willis WH: The three-joint complex in Weinstein J Wiesel SW (eds): The Lumbar Spine. Philadelphia: WB Saunders 1990 pp 80–87

    • Search Google Scholar
    • Export Citation

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