Sushil Basra1, Brandon Bucklen2, Aditya Muzumdar2, Saif Khalil2, Manasa Gudipally3. 1. Long Island Spine Specialists PC, 763 Larkfield Rd, 2nd Floor, Commack, NY 11725, USA. 2. Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA. 3. Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA. Electronic address: manasa.gudipally@gmail.com.
Abstract
BACKGROUND CONTEXT: Lateral spacers (LSs) are the standard of care for a lateral lumbar interbody fusion. However, various types of fixation, such as bilateral pedicle screws (BPSs), unilateral pedicle screws (UPSs), bilateral facet screws (BFSs), and lateral plates (LPs) have been reported to increase the stability of LSs. The biomechanics of a novel lateral interbody implant, which is an interbody spacer with an integrated plate and two bone screws (lateral integrated plate-spacer [IPS-L]), has not been investigated yet. PURPOSE: To compare the biomechanical stability of IPS-L and LS with and without supplemental instrumentation. STUDY DESIGN: Human lumbar cadaveric study evaluating the biomechanical stability of an IPS-L. METHODS: Each of the six (L2-L5) spines was sequentially tested in intact; IPS-L; IPS-L+UPS; IPS-L+BPS; IPS-L+BFS; LS+BFS; LS+UPS; LS+BPS; LS; and LS+LP, using a load-control protocol in which a ±8 Nm moment was applied, for three cycles each, in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Data results were obtained from the third cycle. RESULTS: The IPS-L construct significantly reduced the range of motion (ROM) by 75% in FE, 70% in LB, and 57% in AR, compared with intact. Lateral integrated plate-spacer demonstrated similar biomechanical stability as LS+LP, and higher stability than the LS-alone construct, but the difference was not statistically significant. CONCLUSIONS: The IPS-L evaluated in the present study demonstrated equivalent biomechanical stability compared with standard lateral interbody fusion constructs. The addition of BPSs to the IPS-L showed significant reduction in ROM in FE, and the addition of BFSs showed significant reduction in ROM in FE and AR, compared with the integrated plate-spacer alone construct. The IPS-L with supplemental fixation may be a viable option for lateral interbody fusion. Long-term clinical studies are further required to confirm these results.
BACKGROUND CONTEXT: Lateral spacers (LSs) are the standard of care for a lateral lumbar interbody fusion. However, various types of fixation, such as bilateral pedicle screws (BPSs), unilateral pedicle screws (UPSs), bilateral facet screws (BFSs), and lateral plates (LPs) have been reported to increase the stability of LSs. The biomechanics of a novel lateral interbody implant, which is an interbody spacer with an integrated plate and two bone screws (lateral integrated plate-spacer [IPS-L]), has not been investigated yet. PURPOSE: To compare the biomechanical stability of IPS-L and LS with and without supplemental instrumentation. STUDY DESIGN:Human lumbar cadaveric study evaluating the biomechanical stability of an IPS-L. METHODS: Each of the six (L2-L5) spines was sequentially tested in intact; IPS-L; IPS-L+UPS; IPS-L+BPS; IPS-L+BFS; LS+BFS; LS+UPS; LS+BPS; LS; and LS+LP, using a load-control protocol in which a ±8 Nm moment was applied, for three cycles each, in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Data results were obtained from the third cycle. RESULTS: The IPS-L construct significantly reduced the range of motion (ROM) by 75% in FE, 70% in LB, and 57% in AR, compared with intact. Lateral integrated plate-spacer demonstrated similar biomechanical stability as LS+LP, and higher stability than the LS-alone construct, but the difference was not statistically significant. CONCLUSIONS: The IPS-L evaluated in the present study demonstrated equivalent biomechanical stability compared with standard lateral interbody fusion constructs. The addition of BPSs to the IPS-L showed significant reduction in ROM in FE, and the addition of BFSs showed significant reduction in ROM in FE and AR, compared with the integrated plate-spacer alone construct. The IPS-L with supplemental fixation may be a viable option for lateral interbody fusion. Long-term clinical studies are further required to confirm these results.
Authors: Dominik Adl Amini; Manuel Moser; Lisa Oezel; Jiaqi Zhu; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Alexander P Hughes Journal: Eur Spine J Date: 2021-10-28 Impact factor: 2.721
Authors: Ripul Panchal; Ryan Denhaese; Clint Hill; K Brandon Strenge; Alexandre DE Moura; Peter Passias; Paul Arnold; Andrew Cappuccino; M David Dennis; Andy Kranenburg; Brieta Ventimiglia; Kim Martin; Chris Ferry; Sarah Martineck; Camille Moore; Kee Kim Journal: Int J Spine Surg Date: 2018-08-03