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01-06-2006 | Original Article

Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal

Authors: Christian H. Flamme, Nadine von der Heide, Caroline Heymann, Christof Hurschler

Published in: European Spine Journal | Issue 6/2006

Abstract

This is a comparative in vitro biomechanical study of the primary stability of an anterior lumbar interbody stabilization. The objective was to compare the stability of a interbody stabilizing titanium cage with and without the retention of the bordering vertebral endplates, as well as to compare the titanium cage with a tricalcium phosphate block when the endplates are removed. An adequate blood supply is critical for interbody fusion, which suggests surgical treatment of the bordering endplates. On the other hand, primary stability is improved by the retention of the endplates. Furthermore, bone substitute materials are finding more frequent use due to complications associated with autologous bone grafts. Ten bovine lumbar spine motion segments (average age 6 months) were investigated. Pure bending loadings as well as eccentric axial compression loadings were applied. A titanium cage and tricalcium phosphate block, were tested in conjunction with an anterior augmentation (MACS). Range of motion, neutral zone (NZ) and bending stiffness were measured under pure bending to 10 Nm, and bending stiffness under axial loads of up to 1500 N. Range of motion of both implants in flexion-extension was significantly smaller than physiologic (cage without endplates 4.3°, cage with 2.8°, block without 3.4°, and physiologic 6.6°, all p<0.001). The cage with endplates and the block without endplates were both significantly stiffer than physiologic in all directions except left lateral bending. The block without endplates and the cage with endplates were both stiffer than the cage without endplates. The results suggest that the use of the bone substitute block provides better stability than the cage when the endplates are removed.

An HS, Lim TH, You JW, Hong JH, Eck J, McGrady L (1995) Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine 20:1979–1983PubMed

Bader RJ, Steinhauser E, Rechl H, Mittelmeier W, Bertagnoli R, Gradinger R (2002) Mechanische untersuchungen von lumbalen interkorporellen Fusionsimplantaten. Orthopäde 31:459–465PubMed

Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060PubMed

Beisse R, Potulski M, Beger J, Bühren V (2002) Entwicklung und klinischer Einsatz einer thorakoskopisch implantierbaren Rahmenplatte zur Behandlung thorakolumbaler Frakturen und Instabilitäten. Orthopäde 31:413–422PubMed

Boden SD, Martin GJ Jr, Morone MA, Ugbo JL, Moskovitz PA (1999) Posterolateral lumbar intertransverse process spine arthrodesis with recombinant human bone morphogenetic protein 2/hydroxyapatite–tricalcium phosphate after laminectomy in the nonhuman primate. Spine 24:1179–1185CrossRefPubMed

Brantigan JW, McAfee PC, Cunningham BW, Wang H, Orbegoso CM (1994) Interbody lumbar fusion using a carbon fiber cage implant versus allograft bone. An investigational study in the Spanish goat. Spine 19:1436–1444PubMed

Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA (1997) Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine 22:26–31CrossRefPubMed

Closkey RF, Parsons JR, Lee CK, Blacksin MF, Zimmerman MC (1993) Mechanics of interbody spinal fusion. Analysis of critical bone graft area. Spine 18:1011–1015PubMed

Cook SD, Dalton JE, Tan EH, Tejeiro WV, Young MJ, Whitecloud TS (1994) In vivo evaluation of anterior cervical fusions with hydroxylapatite graft material. Spine 19:1856–1866PubMed

10.

Cotterill PC, Kostuik JP, D’Angelo G, Fernie GR, Maki BE (1986) An anatomical comparison of the human and bovine thoracolumbar spine. J Orthop Res 4:298–303CrossRefPubMed

11.

Emery SE, Fuller DA, Stevenson S (1996) Ceramic anterior spinal fusion. Biologic and biomechanical comparison in a canine model. Spine 21:2713–2719CrossRefPubMed

12.

Eysel P (2000) Biomechanical principles of ventral and dorsal instrumentation correction in scoliosis. Biomechanische Korrekturprinzipien ventraler und dorsaler Instrumentationen bei Skoliosen. Orthopade 29:507–517CrossRefPubMed

13.

Eysel P, Furderer S, Rompe JD, Zollner J (2000) Initial instability of different cages for fusion of the cervical spine. Zentralbl Neurochir 61:171–176CrossRefPubMed

14.

Fuller DA, Stevenson S, Emery SE (1996) The effects of internal fixation on calcium carbonate. Ceramic anterior spinal fusion in dogs. Spine 21:2131–2136CrossRefPubMed

15.

Fürderer S, Schöllhuber F, Rompe JD, Eysel P (2002) Einfluss von Design und Implantationstechnik auf das Risiko der progredienten Sinterung verschiedener HWS-Cages. Orthopäde 31:466–471PubMed

16.

Gauthier O, Bouler JM, Aguado E, Pilet P, Daculsi G (1998) Macroporous biphasic calcium phosphate ceramics: influence of macropore diameter and macroporosity percentage on bone ingrowth. Biomaterials 19:133–139CrossRefPubMed

17.

Glazer PA, Colliou O, Klisch SM, Bradfore DS, Bueff HU, Lotz JC (1997) Biomechanical analysis of multilevel fixation methods in the lumbar spine. Spine 22:171–182CrossRefPubMed

18.

Grant JP, Oxland TR, Dvorak MF (2001) Mapping the structural properties of the lumbosacral vertebral endplates. Spine 26:889–896CrossRefPubMed

19.

Grupp TM, Beisse R, Potulski M, Marnay T, Beger J, Blömer W (2002) Mechanische Testung der Implantateigenschaften eines thorakoskopisch implantierbaren ventralen Wirbelsäulenistabilisierungssystems. Orthopäde 31:406–412PubMed

20.

Gunther KP, Scharf HP, Pesch HJ, Puhl W (1998) Integration properties of bone substitute materials. Experimental studies on animals. Einwachsverhalten von Knochenersatzstoffen. Tierexperimentelle Untersuchung. Orthopade 27:105–117CrossRefPubMed

21.

Hasegawa K, Abe M, Washio T, Hara T (2001) An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density. Spine 26:957–963CrossRefPubMed

22.

Heller JG, Zdeblick T, Kunz DA, McCabe R, Cooke ME (1993) Spinal instrumentation for metastatic disease: in vitro biomechanical analysis. J Spinal Disord 6:17–22PubMed

23.

Hollowell JP, Vollmer DG, Wilson CR, Pintar FA, Yoganandan N (1996) Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate? Spine 21:1032–1036CrossRefPubMed

24.

Holte DC, O’Brien JP, Renton P (1994) Anterior lumbar fusion using a hybrid interbody graft. A preliminary radiographic report. Eur Spine J 3:32–38PubMed

25.

Kanayama M, Cunningham BW, Haggerty CJ, Abumi K, Kaneda K, McAfee PC (2000) In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusionI. J Neurosurg 93 (2):259–265PubMed

26.

Kettler A, Dietl R, Krammer M, Lumenta CB, Claes L, Wilke HJ (2002) Dislokationstendenz, stabilisierende Wirkung und Einbruchtendenz unterschiedlicher LWS-Cages im In-virto-Experiment. Orthopäde 31:481–487PubMed

27.

Knop C, Lange U, Bastian L, Blauth M (2001) Biomechanical stability with a new artificial vertebral body implant. 3-dimensional movement analysis of instrumented human vertebral segments. Biomechanische Stabilität mit einem neuen Wirbelkörperersatzimplantat. Unfallchirurg 104:984–997CrossRefPubMed

28.

Knop C, Lange U, Bastian L, Oeser M, Blauth M (2001) Comparative biomechanical compression trials with a new vertebral prosthetic implant. Vergleichende biomechanische Kompressionsversuche mit einem neuen Wirbelkörperersatzimplantat. Unfallchirurg 104:25–33CrossRefPubMed

29.

Kozak JA, Heilman AE, O’Brien JP (1994) Anterior lumbar fusion options. Technique and graft materials. Clin Orthop 300:45–51PubMed

30.

Lee SW, Lim TH, You JW, An HS (2000) Biomechanical effect of anterior grafting devices on the rotational stability of spinal constructs. J Spinal Disord 13:150–155CrossRefPubMed

31.

Lim TH, Kwon H, Jeon CH, Kim JG, Sokolowski M, Natarajan R, An HS, Andersson GB (2001) Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion. Spine 26:951–956CrossRefPubMed

32.

Mittelmeier H, Mittelmeier W, Gleitz M (1998) Pyrost, a spongious, mineral bone substitute. Experimental bases and 13-year clinical experience in over 1000 cases. Mineralisches, spongiöses Knochenersatzmaterial Pyrost. Experimentelle Grundlagen und 13 Jahre klinische Erfahrung bei über 1000 Fällen. Orthopade 27:126–135CrossRefPubMed

33.

Morlock M, Strandborg J, Sellenschloh K, Nassutt R, Püschel K, Eggers C (2002) Vergleich unterschiedlicher Wirbelkörperersatzsysteme hinsichtlich Migration und Primärstabilität bei dorsoventraler Spondylodese nach Korporektomie mit und ohne Laminektomie. Orthopäde 31:514–521PubMed

34.

Morone MA, Boden SD (1998) Experimental posterolateral lumbar spinal fusion with a demineralized bone matrix gel. Spine 23:159–167CrossRefPubMed

35.

Muller-Mai C, Voigt C, Hering A, Rahmanzadeh R, Gross U (2001) Madreporic hydroxyapatite granulates for filling bone defects. Madreporische Hydroxylapatitgranulate zur Füllung ossärer Defekte. Unfallchirurg 104:221–229CrossRefPubMed

36.

Oda I, Cunningham BW, Abumi K, Kaneda K, McAfee PC (1999) The stability of reconstruction methods after thoracolumbar total spondylectomy. An in vitro investigation. Spine 24:1634–1638CrossRefPubMed

37.

Oxland TR, Lund T (2000) Biomechanics of the stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9(Suppl 1):95–101

38.

Oxland T, Panjabi MM, Southern EP (1991) An anatomic basis for spinal instability: a porcine trauma model. J Orthop Res 9:462CrossRef

39.

Paar O, Andereya S, Staatz G, Ambacher T, Erli HJ (2001) Value of human recombinant osteogenetic proteins as bone replacement materials in lumbar spondylodesis. Results of an animal experiment study. Wertigkeit von rekombinantem humanem osteogenetischem Protein als Knochenersatzmaterial bei der lumbalen Spondylodese. Unfallchirurg 104:700–709CrossRefPubMed

40.

Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine 13:1129–1134PubMed

41.

Panjabi MM (1991) Three-dimensional testing of the stability of spinal implants. Dreidimensionale Testung der Stabilität von Wirbelsäulenimplantaten. Orthopade 20:106–111PubMed

42.

Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390–396PubMed

43.

Panjabi M, White AA (1990) Physical properties and functional biomechanics of the spine. In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine. Lippincott, Philadelphia, pp 1–83

44.

Panjabi MM, Krag MH, Summers D, Videman T (1985) Biomechanical time-tolerance of fresh cadaveric human spine specimens. J Orthop Res 3:292–300CrossRefPubMed

45.

Pintar FA, Maiman DJ, Hollowell JP, Yoganandan N, Droese KW, Reinartz JM, Cuddy B (1994) Fusion rate and biomechanical stiffness of hydroxylapatite versus autogenous bone grafts for anterior discectomy. An in vivo animal study. Spine 19:2524–2528PubMed

46.

Pitzen T, Geisler H, Matthis H, Müller-Storz H, Pedersen K, Steudel WI (2000) The influence of cancellous bone density on load-sharing in human lumbar spine in compression, a comparison between an intact and surgically altered motion segment. In: Kienapfel H, Jones D, Rüther W (eds) European orthopaedic research society, vol. 10. Annual conference. EORS; Marburg, pp 0–75

47.

Rueger JM (1998) Bone substitution materials. Current status and prospects. Knochenersatzmittel. Heutiger Stand und Ausblick. Orthopade 27:72–79CrossRefPubMed

48.

Rueger JM, Linhart W, Sommerfeldt D (1998) Biologic reactions to calcium phosphate ceramic implantations. Results of animal experiments. Biologische Reaktionen auf Kalziumphosphatkeramik-Implantationen. Tierexperimentelle Ergebnisse. Orthopade 27:89–95CrossRefPubMed

49.

Schnee CL, Freese A, Weil RJ, Marcotte PJ (1997) Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22:2222–2227CrossRefPubMed

50.

Schneid S, Sabitzer RJ, Fuss FK, Grupp TM, Blömer W (2002) In-vitro-Stabilitätsuntersuchungen eines neuartigen Implantatsystems für den minimal-invasiven transforaminalen Zugang. Orthopäde 31:488–493PubMed

51.

Schultheiss M, Wilke HJ, Claes L, Kinzl L, Hartwig E (2002) MACS-TL-Polyaxialscrew XL. Orthopäde 31:397–401PubMed

52.

Schultheiss M, Wilke HJ, Claes L, Kinzl L, Hartwig E (2002) MACS-TL-twin-screw. Orthopäde 31:362–367PubMed

53.

Scifert JL, Sairyo K, Goel VK, Grobler LJ, Grosland NM, Spratt KF, Chesmel KD (1999) Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model. Spine 24:2206–2213CrossRefPubMed

54.

Senter HJ, Kortyna R, Kemp WR (1989) Anterior cervical discotomy with hydroxylapatite fusion. Neurosurgery 25(1):39–43CrossRefPubMed

55.

Snedecor GW, Cochran WG (1989) Statistical methods. Iowa State University Press, Ames, Iowa

56.

Spiegel DA, Cunningham BW, Oda I, Dormans JP, McAfee PC, Drummond DS (2000) Anterior vertebral screw strain with and without solid interspace support. Spine 25:2755–2761CrossRefPubMed

57.

Stutzle H, Hallfeldt K, Mandelkow H, Kessler S, Schweiberer L (1998) Bone regeneration stimulated by bone substitute materials. Knochenneubildung durch Knochenersatzmaterialien. Orthopade 27:118–125CrossRefPubMed

58.

Tencer AF, Hampton D, Eddy S (1995) Biomechanical properties of threaded inserts for lumbar interbody spinal fusion. Spine 20:2408–2414PubMed

59.

Thalgott JS, Fritts K, Giuffre JM, Timlin M (1999) Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299CrossRefPubMed

60.

Toth JM, An HS, Lim TH, Ran Y, Weiss NG, Lundberg WR, Xu RM, Lynch KL (1995) Evaluation of porous biphasic calcium phosphate ceramics for anterior cervical interbody fusion in a caprine model. Spine 20:2203–2210PubMed

61.

Vahldiek MJ, Panjabi MM (1998) Stability potential of spinal instrumentations in tumor vertebral body replacement surgery. Spine 23:543–550CrossRefPubMed

62.

Weiner BK, Fraser RD (1998) Spine update lumbar interbody cages. Spine 23:634–640CrossRefPubMed

63.

Wilke HJ, Kettler A, Wenger KH, Claes LE (1997) Anatomy of the sheep spine and its comparison to the human spine. Anat Rec 247:542–555CrossRefPubMed

64.

Wilke HJ, Krischak ST, Wenger KH, Claes LE (1997) Load-displacement properties of the thoracolumbar calf spine: experimental results and comparison to known human data. Eur Spine J 6:129–137CrossRefPubMed

65.

Wilke HJ, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7:148–154CrossRefPubMed

66.

Zdeblick TA, Smith GR, Warden KE, Eng MB, McAfee PC (1991) Two-point fixation of the lumbar spine. Differential stability in rotation. Spine 16:S298–S301PubMed

67.

Zdeblick TA, Warden KE, Zou D, McAfee PC, Abitbol JJ (1993) Anterior spinal fixators. A biomechanical in vitro study. Spine 18:513–517PubMed

Title: Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal
Authors: Christian H. Flamme
Nadine von der Heide
Caroline Heymann
Christof Hurschler
Publication date: 01-06-2006
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 6/2006
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-005-0993-4

At a glance: The STEP trials

Springer Medicine

Primary stability of anterior lumbar stabilization: interdependence of implant type and endplate retention or removal

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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