Biomechanical Evaluation of Lumbar Lateral Interbody Fusion for the Treatment of Adjacent Segment Disease

Publication date: Available online 7 September 2018

Source: The Spine Journal

Author(s): Mark Shasti, Scott J. Koenig, Alysa B. Nash, Shahrzad Bahrami, Julio J. Jauregui, Nathan N. O'Hara, Ehsan Jazini, Daniel E. Gelb, Steven C. Ludwig

ABSTRACT

BACKGROUND CONTEXT

Adjacent segment disease (ASD) is a well-known complication after lumbar fusion. Lumbar lateral interbody fusion (LLIF) may provide an alternative method of treatment for ASD while avoiding the morbidity associated with revision surgery through a traditional posterior approach. This is the first biomechanical study to evaluate the stability of lateral-based constructs for treating ASD in existing multilevel fusion model.

PURPOSE

We aimed to evaluate the biomechanical stability of anterior column reconstruction through the less invasive lateral-based interbody techniques compared to traditional posterior spinal fusion for the treatment of ASD in existing multilevel fusion.

STUDY DESIGN/SETTING

Cadaveric biomechanical study of laterally based interbody strategies for treating ASD.

METHODS

Eighteen fresh-frozen cadaveric specimens were non-destructively loaded in flexion, extension, and lateral bending. The specimens were randomized into three different groups according to planned posterior spinal instrumented-fusion (PSF): Group 1: L5-S1, Group 2: L4-S1, Group 3: L3- S1. In each group, ASD was considered the level cranial to the upper-instrumented vertebrae (UIV). After testing the intact spine, each specimen underwent PSF representing prior fusion in the ASD model. The adjacent segment for each specimen then underwent a) Stand-alone LLIF, b) LLIF + plate, c) LLIF + single screw-rod (SSR) anterior instrumentation, d) LLIF + traditional posterior extension of PSF. In all conditions, three-dimensional kinematics were tracked, and range of motion (ROM) was calculated for the comparisons.

RESULTS

ROM results were expressed as a percentage of the intact spine ROM. LLIF effectively reduces ROM in all planes of ROM. Supplementation of LLIF with plate or SSR provides further stability as compared to stand alone LLIF. Expansion of posterior instrumentation provides the most substantial stability in all planes of ROM (p<0.05). All constructs demonstrated a consistent trend of reduction in ROM between all the groups in all bending motions.

CONCLUSIONS

This biomechanical study suggests potential promise in exploring LLIF as an alternative treatment of ASD but reinforces previous studies' findings that traditional expansion of posterior instrumentation provides the most biomechanically stable construct.

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