Tailoring selection of transforaminal interbody spacers based on biomechanical characteristics and surgical goals: evaluation of an expandable spacer.

08:00 EDT 12th April 2019 | BioPortfolio

Summary of "Tailoring selection of transforaminal interbody spacers based on biomechanical characteristics and surgical goals: evaluation of an expandable spacer."

OBJECTIVETransforaminal lumbar interbody fusion (TLIF) is commonly used for lumbar fusion, such as for foraminal decompression, stabilization, and improving segmental lordosis. Although many options exist, surgical success is contingent on matching design strengths with surgical goals. The goal in the present study was to investigate the effects of an expandable interbody spacer and 2 traditional static spacer designs in terms of stability, compressive stiffness, foraminal height, and segmental lordosis.METHODSStandard nondestructive flexibility tests (7.5 N⋅m) were performed on 8 cadaveric lumbar specimens (L3-S1) to assess intervertebral stability of 3 types of TLIF spacers at L4-5 with bilateral posterior screw-rod (PSR) fixation. Stability was determined as range of motion (ROM) in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Compressive stiffness was determined with axial compressive loading (300 N). Foraminal height, disc height, and segmental lordosis were evaluated using radiographic analysis after controlled PSR compression (170 N). Four conditions were tested in random order: 1) intact, 2) expandable interbody cage with PSR fixation (EC+PSR), 3) static ovoid cage with PSR fixation (SOC+PSR), and 4) static rectangular cage with PSR fixation (SRC+PSR).RESULTSAll constructs demonstrated greater stability than the intact condition (p < 0.001). No significant differences existed among constructs in ROM (FE, AR, and LB) or compressive stiffness (p ≥ 0.66). The EC+PSR demonstrated significantly greater foraminal height at L4-5 than SRC+PSR (21.1 ± 2.6 mm vs 18.6 ± 1.7 mm, p = 0.009). EC+PSR demonstrated higher anterior disc height than SOC+PSR (14.9 ± 1.9 mm vs 13.6 ± 2.2 mm, p = 0.04) and higher posterior disc height than the intact condition (9.4 ± 1.5 mm vs 7.1 ± 1.0 mm, p = 0.002), SOC+PSR (6.5 ± 1.8 mm, p < 0.001), and SRC+PSR (7.2 ± 1.2 mm, p < 0.001). There were no significant differences in segmental lordosis among SOC+PSR (10.1° ± 2.2°), EC+PSR (8.1° ± 0.5°), and SRC+PSR (11.1° ± 3.0°) (p ≥ 0.06).CONCLUSIONSAn expandable interbody spacer provided stability, stiffness, and segmental lordosis comparable to those of traditional nonexpandable spacers of different shapes, with increased foraminal height and greater disc height. These results may help inform decisions about which interbody implants will best achieve surgical goals.


Journal Details

This article was published in the following journal.

Name: Journal of neurosurgery. Spine
ISSN: 1547-5646
Pages: 1-7


DeepDyve research library

PubMed Articles [21404 Associated PubMed Articles listed on BioPortfolio]

Biomechanical effects of an oblique lumbar PEEK cage and posterior augmentation.

Lumbar interbody spacers are widely used in lumbar spinal fusion. The goal of this study is to analyze the biomechanics of a lumbar interbody spacer (Clydesdale Spinal System, Medtronic Sofamor Danek,...

Analysis of cost and 30 day outcomes in single level transforaminal lumbar interbody fusion (TLIF) and less invasive, standalone lateral transpsoas interbody fusion (LIF).

A comparative evaluation of operative costs between single level transforaminal interbody fusion (TLIF) and standalone lateral transpsoas interbody fusion (LIF) has not yet been done.

Management of infected transforaminal lumbar interbody fusion (TLIF) cage in posterior degenerative lumbar spine surgery.

Postoperative infection rates for transforaminal lumbar interbody fusion (TLIF) range from

Radiographic analysis of minimally invasive transforaminal lumbar interbody fusion versus conventional open surgery on sagittal lumbar-pelvic alignment for degenerative spondylolisthesis.

To compare the impact of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with open posterior lumbar interbody fusion (PLIF) on sagittal lumbar-pelvic radiographic parameters for d...

Fully-endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia/conscious sedation: a case series.

To evaluate clinical outcomes of a case series of 18 patients who underwent fully endoscopic foraminotomy, laminectomy and transforaminal lumbar interbody fusion (TLIF) combined with percutaneous scre...

Clinical Trials [5837 Associated Clinical Trials listed on BioPortfolio]

Unilateral Versus Bilateral TLIF for Degenerative Lumbar Spondylolisthesis

A prospective randomized controlled trial for comparison of radiologic outcomes of "single level transforaminal interbody fusion(TLIF) technique via unilateral versus bilateral facetectomy...

Anterior Bridging Cage With Bone Substitute Versus Localized Autobone in Transforaminal Lumbar Interbody Arthrodesis

The purpose of this study is to evaluation for the pattern of bone bridging of patients who undergo transforaminal lumbar interbody arthrodesis, the investigators hypothesize that auto loc...

A Multi-center, Comparative Clinical Trial to Evaluate the Efficacy and Safety of Inject BMP in Patients Undergoing Transforaminal Lumbar Interbody Fusion

A Randomized, Subject-Assessor Blind, Multi-center, Comparative Clinical Trial to evaluate the efficacy and safety of Inject BMP in Patients Undergoing Transforaminal Lumbar Interbody Fusi...

Autologous Bone Marrow Concentrate in Elective Tranforaminal Lumbar Interbody Fusion Surgery

This study aims to evaluate the effect of bone marrow concentration on bone healing and spinal fusion by comparing clinical and imaging outcomes between patients receiving transforaminal l...

Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

A study that compares between Open TLIF and Minimally invasive TLIF regarding patients' functional status(Oswestry Disability index)as a primary outcome measure.

Medical and Biotech [MESH] Definitions

The intergenic DNA segments that are between the ribosomal RNA genes (internal transcribed spacers) and between the tandemly repeated units of rDNA (external transcribed spacers and nontranscribed spacers).

The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample.

The selection or choice of sexual partner in animals. Often this reproductive preference is based on traits in the potential mate, such as coloration, size, or behavioral boldness. If the chosen ones are genetically different from the rejected ones, then NATURAL SELECTION is occurring.

Those characteristics that distinguish one SEX from the other. The primary sex characteristics are the OVARIES and TESTES and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction.

Therapeutic approach tailoring therapy for genetically defined subgroups of patients.

Quick Search


DeepDyve research library

Relevant Topic

Surgical treatments
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...

Searches Linking to this Article