Scientific article
English

Position of interbody spacer in transforaminal lumbar interbody fusion: effect on 3-dimensional stability and sagittal lumbar contour

Published inJournal of spinal disorders & techniques, vol. 21, no. 3, p. 175-180
Publication date2008
Abstract

STUDY DESIGN: Biomechanical study. OBJECTIVE: To test 2 different intervertebral positions of a semilunar cage and their effects on 3-dimensional stability and segmental lordosis in a model of transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA: In his original TLIF description, Harms recommended decortication of endplates, followed by placement of mesh cages in the middle-posterior intervertebral third. Subsequent studies presented conflicting recommendations: anterior placement of the spacer-cage for better load-sharing versus placement on the stronger posterolateral endplate regions. METHODS: Six human lumbar spinal functional units were first tested intact. TLIF was performed using a semilunar poly-ether-ether-ketone cage randomly inserted in the anterior (TLIF-A) or posterior (TLIF-P) disc space. Pedicle screws and rods were added. Unconstrained pure moments in axial-torsion, lateral-bending (LB), and flexion-extension (FE) were applied under 0.05 Hz and +/-5 Nm sinusoidal waveform. Segmental motions were recorded. Range of motion (ROM) and neutral zone (NZ) were calculated. Pairwise comparisons were made using nonparametric Wilcoxon-matched pairs signed rank sum test with statistical significance set at P<0.05. RESULTS: TLIF-A and TLIF-P significantly decreased ROM (P<0.05) of the intact spinal functional unit, in FE and LB. In axial-torsion, decrease of ROM after TLIF procedures was not significant (P>0.05). Delta-ROM between TLIF-A and TLIF-P was not significant (P>0.05). TLIF-A and TLIF-P significantly decreased NZ in LB (P<0.05). In FE, TLIF-P significantly decreased NZ (P<0.05); TLIF-A showed a trend toward significance (P=0.09). Delta-NZ between TLIF-A and TLIF-P was not significant (P>0.05). Segmental lordosis of TLIF-A and TLIF-P on C-arm views showed angle differences within the range of measurement error of Cobb angles. CONCLUSIONS: Difference in ROM and NZ between anterior (TLIF-A) or posterior (TLIF-P) positions was not statistically significant. Similarly, both positions did not influence segmental lordosis.

Keywords
  • Aged
  • Biomechanics
  • Bone Screws
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Lordosis/surgery
  • Lumbar Vertebrae/surgery
  • Male
  • Middle Aged
  • Spinal Fusion/instrumentation/methods
  • Treatment Outcome
Citation (ISO format)
FAUNDEZ, Antonio et al. Position of interbody spacer in transforaminal lumbar interbody fusion: effect on 3-dimensional stability and sagittal lumbar contour. In: Journal of spinal disorders & techniques, 2008, vol. 21, n° 3, p. 175–180. doi: 10.1097/BSD.0b013e318074bb7d
Main files (1)
Article (Accepted version)
accessLevelRestricted
Identifiers
Journal ISSN1536-0652
614views
2downloads

Technical informations

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First validation05/03/2009 17:45:00
Update time14/03/2023 16:03:07
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