Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion

Dean G. Karahalios, Taro Kaibara, Randall W. Porter, Udaya K. Kakarla, Phillip M. Reyes, Mhd-Ali - Baaj, Ali S. Yaqoobi, Neil R. Crawford

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Object. An interspinous anchor (ISA) provides fixation to the lumbar spine to facilitate fusion. The biomechanical stability provided by the Aspen ISA was studied in applications utilizing an anterior lumbar interbody fusion (ALIF) construct. Methods. Seven human cadaveric L3-S1 specimens were tested in the following states: 1) intact; 2) after placing an ISA at L4-5; 3) after ALIF with an ISA; 4) after ALIF with an ISA and anterior screw/plate fixation system; 5) after removing the ISA (ALIF with plate only); 6) after removing the plate (ALIF only); and 7) after applying bilateral pedicle screws and rods. Pure moments (7.5 Nm maximum) were applied in flexion and extension, lateral bending, and axial rotation while recording angular motion optoelectronically. Changes in angulation as well as foraminal height were also measured. Results. All instrumentation variances except ALIF alone reduced angular range of motion (ROM) significantly from normal in all directions of loading. The ISA was most effective in limiting flexion and extension (25% of normal) and less effective in reducing lateral bending (71% of normal) and axial rotation (71% of normal). Overall, ALIF with an ISA provided stability that was statistically equivalent to ALIF with bilateral pedicle screws and rods. An ISA-augmented ALIF allowed less ROM than plate-augmented ALIF during flexion, extension, and lateral bending. Use of the ISA resulted in flexion at the index level, with a resultant increase in foraminal height. Compensatory extension at the adjacent levels prevented any significant change in overall sagittal balance. Conclusions. When used with ALIF at L4-5, the ISA provides immediate rigid immobilization of the lumbar spine, allowing equivalent ROM to that of a pedicle screw/rod system, and smaller ROM than an anterior plate. When used with ALIF, the ISA may offer an alternative to anterior plate fixation or bilateral pedicle screw/rod constructs.

Original languageEnglish (US)
Pages (from-to)372-380
Number of pages9
JournalJournal of Neurosurgery: Spine
Volume12
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Articular Range of Motion
Biomechanical Phenomena
Spine
Immobilization
Pedicle Screws

Keywords

  • Anterior lumbar interbody fusion
  • Biomechanics
  • Lumbar spine
  • Plate fixation
  • Posterior lumbar fixation
  • Spinous process

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Karahalios, D. G., Kaibara, T., Porter, R. W., Kakarla, U. K., Reyes, P. M., Baaj, M-A. ., ... Crawford, N. R. (2010). Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion. Journal of Neurosurgery: Spine, 12(4), 372-380. https://doi.org/10.3171/2009.10.SPINE09305

Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion. / Karahalios, Dean G.; Kaibara, Taro; Porter, Randall W.; Kakarla, Udaya K.; Reyes, Phillip M.; Baaj, Mhd-Ali -; Yaqoobi, Ali S.; Crawford, Neil R.

In: Journal of Neurosurgery: Spine, Vol. 12, No. 4, 04.2010, p. 372-380.

Research output: Contribution to journalArticle

Karahalios, DG, Kaibara, T, Porter, RW, Kakarla, UK, Reyes, PM, Baaj, M-A, Yaqoobi, AS & Crawford, NR 2010, 'Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion', Journal of Neurosurgery: Spine, vol. 12, no. 4, pp. 372-380. https://doi.org/10.3171/2009.10.SPINE09305
Karahalios, Dean G. ; Kaibara, Taro ; Porter, Randall W. ; Kakarla, Udaya K. ; Reyes, Phillip M. ; Baaj, Mhd-Ali - ; Yaqoobi, Ali S. ; Crawford, Neil R. / Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion. In: Journal of Neurosurgery: Spine. 2010 ; Vol. 12, No. 4. pp. 372-380.
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abstract = "Object. An interspinous anchor (ISA) provides fixation to the lumbar spine to facilitate fusion. The biomechanical stability provided by the Aspen ISA was studied in applications utilizing an anterior lumbar interbody fusion (ALIF) construct. Methods. Seven human cadaveric L3-S1 specimens were tested in the following states: 1) intact; 2) after placing an ISA at L4-5; 3) after ALIF with an ISA; 4) after ALIF with an ISA and anterior screw/plate fixation system; 5) after removing the ISA (ALIF with plate only); 6) after removing the plate (ALIF only); and 7) after applying bilateral pedicle screws and rods. Pure moments (7.5 Nm maximum) were applied in flexion and extension, lateral bending, and axial rotation while recording angular motion optoelectronically. Changes in angulation as well as foraminal height were also measured. Results. All instrumentation variances except ALIF alone reduced angular range of motion (ROM) significantly from normal in all directions of loading. The ISA was most effective in limiting flexion and extension (25{\%} of normal) and less effective in reducing lateral bending (71{\%} of normal) and axial rotation (71{\%} of normal). Overall, ALIF with an ISA provided stability that was statistically equivalent to ALIF with bilateral pedicle screws and rods. An ISA-augmented ALIF allowed less ROM than plate-augmented ALIF during flexion, extension, and lateral bending. Use of the ISA resulted in flexion at the index level, with a resultant increase in foraminal height. Compensatory extension at the adjacent levels prevented any significant change in overall sagittal balance. Conclusions. When used with ALIF at L4-5, the ISA provides immediate rigid immobilization of the lumbar spine, allowing equivalent ROM to that of a pedicle screw/rod system, and smaller ROM than an anterior plate. When used with ALIF, the ISA may offer an alternative to anterior plate fixation or bilateral pedicle screw/rod constructs.",
keywords = "Anterior lumbar interbody fusion, Biomechanics, Lumbar spine, Plate fixation, Posterior lumbar fixation, Spinous process",
author = "Karahalios, {Dean G.} and Taro Kaibara and Porter, {Randall W.} and Kakarla, {Udaya K.} and Reyes, {Phillip M.} and Baaj, {Mhd-Ali -} and Yaqoobi, {Ali S.} and Crawford, {Neil R.}",
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AU - Kaibara, Taro

AU - Porter, Randall W.

AU - Kakarla, Udaya K.

AU - Reyes, Phillip M.

AU - Baaj, Mhd-Ali -

AU - Yaqoobi, Ali S.

AU - Crawford, Neil R.

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N2 - Object. An interspinous anchor (ISA) provides fixation to the lumbar spine to facilitate fusion. The biomechanical stability provided by the Aspen ISA was studied in applications utilizing an anterior lumbar interbody fusion (ALIF) construct. Methods. Seven human cadaveric L3-S1 specimens were tested in the following states: 1) intact; 2) after placing an ISA at L4-5; 3) after ALIF with an ISA; 4) after ALIF with an ISA and anterior screw/plate fixation system; 5) after removing the ISA (ALIF with plate only); 6) after removing the plate (ALIF only); and 7) after applying bilateral pedicle screws and rods. Pure moments (7.5 Nm maximum) were applied in flexion and extension, lateral bending, and axial rotation while recording angular motion optoelectronically. Changes in angulation as well as foraminal height were also measured. Results. All instrumentation variances except ALIF alone reduced angular range of motion (ROM) significantly from normal in all directions of loading. The ISA was most effective in limiting flexion and extension (25% of normal) and less effective in reducing lateral bending (71% of normal) and axial rotation (71% of normal). Overall, ALIF with an ISA provided stability that was statistically equivalent to ALIF with bilateral pedicle screws and rods. An ISA-augmented ALIF allowed less ROM than plate-augmented ALIF during flexion, extension, and lateral bending. Use of the ISA resulted in flexion at the index level, with a resultant increase in foraminal height. Compensatory extension at the adjacent levels prevented any significant change in overall sagittal balance. Conclusions. When used with ALIF at L4-5, the ISA provides immediate rigid immobilization of the lumbar spine, allowing equivalent ROM to that of a pedicle screw/rod system, and smaller ROM than an anterior plate. When used with ALIF, the ISA may offer an alternative to anterior plate fixation or bilateral pedicle screw/rod constructs.

AB - Object. An interspinous anchor (ISA) provides fixation to the lumbar spine to facilitate fusion. The biomechanical stability provided by the Aspen ISA was studied in applications utilizing an anterior lumbar interbody fusion (ALIF) construct. Methods. Seven human cadaveric L3-S1 specimens were tested in the following states: 1) intact; 2) after placing an ISA at L4-5; 3) after ALIF with an ISA; 4) after ALIF with an ISA and anterior screw/plate fixation system; 5) after removing the ISA (ALIF with plate only); 6) after removing the plate (ALIF only); and 7) after applying bilateral pedicle screws and rods. Pure moments (7.5 Nm maximum) were applied in flexion and extension, lateral bending, and axial rotation while recording angular motion optoelectronically. Changes in angulation as well as foraminal height were also measured. Results. All instrumentation variances except ALIF alone reduced angular range of motion (ROM) significantly from normal in all directions of loading. The ISA was most effective in limiting flexion and extension (25% of normal) and less effective in reducing lateral bending (71% of normal) and axial rotation (71% of normal). Overall, ALIF with an ISA provided stability that was statistically equivalent to ALIF with bilateral pedicle screws and rods. An ISA-augmented ALIF allowed less ROM than plate-augmented ALIF during flexion, extension, and lateral bending. Use of the ISA resulted in flexion at the index level, with a resultant increase in foraminal height. Compensatory extension at the adjacent levels prevented any significant change in overall sagittal balance. Conclusions. When used with ALIF at L4-5, the ISA provides immediate rigid immobilization of the lumbar spine, allowing equivalent ROM to that of a pedicle screw/rod system, and smaller ROM than an anterior plate. When used with ALIF, the ISA may offer an alternative to anterior plate fixation or bilateral pedicle screw/rod constructs.

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KW - Biomechanics

KW - Lumbar spine

KW - Plate fixation

KW - Posterior lumbar fixation

KW - Spinous process

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