Biomechanics of an Expandable Lumbar Interbody Fusion Cage Deployed Through Transforaminal Approach Journal Article

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Authors: Mica, M. C.; Voronov, L. I.; Carandang, G; Havey, R. M.; Wojewnik, B; Patwardhan, A. G.
Article Title: Biomechanics of an Expandable Lumbar Interbody Fusion Cage Deployed Through Transforaminal Approach
Abstract: Introduction: A novel expandable lumbar interbody fusion cage has been developed which allows for a broad endplate footprint similar to an anterior lumbar interbody fusion (ALIF); however, it is deployed from a minimally invasive transforaminal unilateral approach. The perceived benefit is a stable circumferential fusion from a single approach that maintains the anterior tension band of the anterior longitudinal ligament.The purpose of this biomechanics laboratory study was to evaluate the biomechanical stability of an expandable lumbar interbody cage inserted using a transforaminal approach and deployed in situ compared to a traditional lumbar interbody cage inserted using an anterior approach (control device). Methods: Twelve cadaveric spine specimens (L1-L5) were tested intact and after implantation of both the control and experimental devices in two (L2-L3 and L3-L4) segments of each specimen; the assignments of the control and experimental devices to these segments were alternated. Effect of supplemental pedicle screw-rod stabilization was also assessed. Moments were applied to the specimens in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). The effect of physiologic preload on construct stability was evaluated in FE. Segmental motions were measured using an optoelectronic motion measurement system. Results: The deployable expendable TLIF cage and control devices significantly reduced FE motion with and without compressive preload when compared to the intact condition (p0.05). Adding bilateral pedicle screws resulted in further reduction of ROM for all loading modes compared to intact condition, with no statistical difference between the two constructs (pgt;0.05). Conclusions: The ability of the deployable expendable interbody cage in reducing segmental motions was equivalent to the control cage when used as a stand-alone construct and also when supplemented with bilateral pedicle screw-rod instrumentation. The larger footprint of the fully deployed TLIF cage combined with preservation of the anterior soft-tissue tension band may provide a better biomechanical fusion environment by combining the advantages of the traditional ALIF and TLIF approaches.
Journal Title: International journal of spine surgery
Volume: 11
ISSN: 2211-4599; 2211-4599
Publisher: Unknown  
Journal Place: Netherlands
Date Published: 2017
Start Page: 24
Language: eng
DOI/URL:

10.14444/4024
Notes: LR: 20180128; JID: 101579005; OTO: NOTNLM; 2018/01/27 06:00 [entrez]; 2018/01/27 06:00 [pubmed]; 2018/01/27 06:01 [medline]; epublish