Journal article
Lumbar Intervertebral Spacer With Cement Augmentation of Endplates and Integrated Screws as a Fixation Device in an Osteoporotic Model: An In Vitro Kinematic and Load- to-Failure Study
INTERNATIONAL JOURNAL OF SPINE SURGERY, v 15(2), pp 324-333
01 Apr 2021
PMID: 33900990
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Integrated lateral lumbar interbody fusion (LLIF) devices have been shown to successfully stabilize the spine and avoid complications related to posterior fixation. However, LLIF has increased subsidence risk in osteoporotic patients. Cement augmentation through cannulated pedicle screws enhances pedicle fixation and cageendplate interface yet involves a posterior approach. Lateral application of cement with integrated LLIF fixation has been introduced and requires characterization. The present study set out to evaluate kinematic and load-to-failure properties of a novel cement augmentation technique with an integrated LLIF device, alone and with unilateral pedicle fixation, compared with bilateral pedicle screws and nonintegrated LLIF (BPS thorn S). Methods: Twelve specimens (L3-S1) underwent discectomy at L4-L5. Specimens were separated into 3 groups: (1) BPSthornS; (2) polymethyl methacrylate (PMMA) augmentation, integrated LLIF, and unilateral pedicle screws (PMMA thornUPSthorniS); and (3) PMMA and integrated LLIF (PMMAthorniSA) without posterior fixation. Flexion-extension, lateral bending, and axial rotation were applied. A compressive load was applied to L4-L5 segments until failure. An analysis was performed (P<.05). Results: Operative constructs significantly reduced motion relative to intact specimens in all motion planes (P<.05). BPSthornS provided the most stability, reducing motion by 71.6%-86.4%, followed by PMMAthornUPSthorniS (68.1%79.4%) and PMMA thorn iSA (62.9%-81.9%); no significant differences were found (P..05). PMMA thorn UPS thorn iS provided the greatest resistance to failure (2290 N), followed by PMMA thorn iSA (1970 N) and BPS thorn S (1390 N); no significant differences were observed (P>.05). Conclusions: Cement augmentation of vertebral endplates via the lateral approach with integrated LLIF moderately improved cage-endplate strength compared to BPSthornS in an osteoporotic model; unilateral pedicle fixation further improved failure load. Reconstruction before and after application of unilateral pedicle screws and rods was biomechanically equivalent to anteroposterior reconstruction. Overall, initial results suggest that integrated LLIF with cement augmentation may be a viable alternative in the presence of osteoporosis.
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Details
- Title
- Lumbar Intervertebral Spacer With Cement Augmentation of Endplates and Integrated Screws as a Fixation Device in an Osteoporotic Model: An In Vitro Kinematic and Load- to-Failure Study
- Publication Details
- INTERNATIONAL JOURNAL OF SPINE SURGERY, v 15(2), pp 324-333
- Publisher
- INT SOC ADVANCEMENT SPINE SURGERY-ISASS; WHEATON
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000640535000016
- Scopus ID
- 2-s2.0-85105277037
- Other Identifier
- 991021860669004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery