69. Posterior augmentation of anterior lumbar interbody fusion comparison of facet and pedicle screw fixation

2004 ◽  
Vol 4 (5) ◽  
pp. S36-S37
Author(s):  
Ensor Transfeldt ◽  
Esat Kiter ◽  
Timothy Garvey ◽  
Amir Mehbod ◽  
Manuel Pinto
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion

Augmentation of an anterior lumbar interbody fusion with an anterior plate or pedicle screw fixation: a comparative biomechanical in vitro study

2007 ◽  
Vol 6 (3) ◽  
pp. 267-271 ◽  
Author(s):  
Tann A. Nichols ◽  
Brenda K. Yantzer ◽  
Suzanne Alameda ◽  
Wesley M. Johnson ◽  
Bernard H. Guiot
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Anterior Plate ◽  
Elastic Zone ◽  
Flexion Extension

Object Posterior pedicle screw (PS) instrumentation is often used to augment anterior lumbar interbody fusion (ALIF) but at the cost of an increase in the morbidity rate due to the second approach and screw placement. If anterior plates were found to be biomechanically equivalent to PS fixation (PSF) after ALIF, then this second approach could be avoided without decreasing vertebral stability. Methods Eight cadaveric L5–S1 spinal segments were tested under four conditions: intact, following anterior discectomy and interbody spacer placement, after placement of an anterior plate, and following PSF. The elastic zone and stiffness were calculated for axial compression, flexion/extension, lateral bending, and torsion. Neither anterior plate stabilization nor PSF showed significant intergroup differences in stiffness or the elastic zone. Both exhibited greater stiffness in flexion than the intact specimens (p < 0.001). Pedicle screw fixation was associated with a decreased elastic zone in lateral bending compared with the intact specimen (p < 0.04). Conclusions Anterior plate fixation is biomechanically similar to PSF following ALIF. Surgeons may wish to use anterior plates in place of PSs to avoid the need for a posterior procedure. This may lead to a decrease in operative morbidity and improved overall outcomes.

Sacral fractures following stand-alone L5–S1 anterior lumbar interbody fusion for isthmic spondylolisthesis

2010 ◽  
Vol 13 (2) ◽  
pp. 288-293 ◽  
Author(s):  
Jeffrey F. Lastfogel ◽  
Thomas J. Altstadt ◽  
Richard B. Rodgers ◽  
Eric M. Horn
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
High Stress ◽  
Pedicle Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Integrated System ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Sacral Fractures

Recent studies have demonstrated excellent results in treating isthmic spondylolisthesis via an anterior lumbar interbody fusion (ALIF). The authors describe 3 patients with isthmic spondylolisthesis at L5–S1 who experienced sacral fractures after insertion of a unique, stand-alone anterior interbody fixation device. Three consecutive patients at a single institution were treated for Grade I spondylolisthesis at L5–S1 via a standalone ALIF with insertion of a novel biomechanical interbody device. This device is made of polyetheretherketone and has an integrated system for internal fixation into the vertebral bodies. In each patient a bone morphogenetic protein–soaked sponge was placed for the fusion. The indications for treatment in each patient were back and radicular pain that had been unsuccessfully treated with conservative measures. All 3 patients had reduction of their spondylolisthesis and resolution of their unilateral radiculopathies immediately postoperatively. Within 1 month of surgery, all 3 patients had failure of the device and recurrence of their symptoms. In each case the failure was due to fracture of the anterior portion of the S-1 body. Each patient underwent reduction and pedicle screw fixation at L5–S1. In all cases, there was successful reduction in their recurrent spondylolisthesis and resolution of their radiculopathies. Treatment of Grade I isthmic spondylolisthesis at L5–S1 with stand-alone ALIF and fixation can lead to sacral fracture from high stress loads at that level in the spine, and consideration should be made either for supplemental pedicle screw fixation or a completely posterior approach.

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