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Research ArticleFull Length Article
Open Access

Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study

Brandon G. Santoni, Gerald E. Alexander, Aniruddh Nayak, Andres Cabezas, German A. Marulanda, Ryan Murtagh and Antonio E. Castellvi
International Journal of Spine Surgery January 2013, 7 e101-e108; DOI: https://doi.org/10.1016/j.ijsp.2013.09.001
Brandon G. Santoni
aPhillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL
PhD
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Gerald E. Alexander III
bDepartment of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL
MD
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Aniruddh Nayak
aPhillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL
MS
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Andres Cabezas
aPhillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, Tampa, FL
BS
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German A. Marulanda
bDepartment of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL
MD
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Ryan Murtagh
cUniversity Diagnostic Institute, Tampa, FL
MD
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Antonio E. Castellvi
dCenter for Spinal Disorders, Florida Orthopaedic Institute, Tampa, FL
MD
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  • For correspondence: doctorbackbone@aol.com
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  • Fig. 1
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    Fig. 1

    Radiographic representative images of 2 endplate fractures sustained during lateral interbody cage implantation.

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    Fig. 2

    Test setup for pure moment (A) and cyclic (B) loading of the instrumented lumbar spine fusion constructs.

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    Fig. 3

    Sagittal CT images illustrating posterior disc height (DH), foraminal area (FA), and canal area (CA) measurements. Disc height measurements were made in the sagittal plane. Canal area was measured at the level of the disc for all instrumented levels.

Tables

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    Table 1

    Bone quality, measured cage subsidence, and cage dimensions in levels with endplate fracture

    L1-L4 BMD (g/cm2)T-Score and WHO classificationInterbody cage subsidence (mm)Cage height (mm)Cage dimensions (w × l) (mm)
    AnteriorPosteriorAverage
    Pedicle screw/rod
    Inferior endplate at L4-L50.901−2.7 Osteoporotic5.77.26.51018 × 55
    Lateral plate/screw
      AInferior endplate at L3-L41.008−1.5 Osteopenic2.73.33.01018 × 55
      Inertior endplate at L3-L40.807−3.5 Osteoporotic5.710.98.31218 × 55
      Superior endplate at L4-L51.4942.4 Normal2.42.02.21218 × 55
      BInferior endplate at L3-L40.939−2.1 Osteopenic3.44.03.71018 × 55
    • Abbreviations: BMD, bone mineral density; WHO, World Health Organization.

    • View popup
    Table 2

    ROM results for specimens with endplate fracture subsequent to interbody cage implantation

    Endplate fracture location and levelRange of motion (degree)
    F/ELBAR
    Intact XLIF Percentage reduction (%)Intact XLIF Percentage reduction (%)Intact XLIF Percentage reduction (%)
    Pedicle screw/rod Inferior endplate at L4-L58.35.732.312.85.061.17.86.319.5
    *PSR groupavg. *PSR groupavg. *PSR groupavg.
    n = 17 levels85.4n = 17 levels91.3n = 17 levels64.0
      Lateral plate/screw
      AInferior endplate at L3-L47.611.1−45.77.513.4−77.81.73.6−111.6
      Inertior endplate at L3-L411.19.117.511.412.9−12.93.32.720.2
      Superior endplate at L4-L516.515.65.819.58.854.75.17.2−42.4
      BInferior endplate at L3-L49.85.544.515.57.154.18.63.658.0
    Average11.310.35.513.510.64.54.74.3−19.0
    *ALP group avg. *ALP group avg. *ALP group avg.
    n = 14 levels49.5n = 14 levels67.3n = 14 levels48.2
    • Abbreviations:avg., average; XLIF, extreme lateral interbody fusion.

    • ↵* Average ROM for the respective treatments (PSR and ALP) in specimens with intact endplates.

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    Table 3

    Cage motion results for pedicle/screw rod and anterior-lateral plate specimens with endplate fracture during interbody cage placement

    Endplate fracture location and levelLateral cage translation (mm)
    F/ELBAR
    A-PM-LI-SA-PM-LI-SA-PM-LI-S
    Pedicle screw/rod Inferior endplate at L4-L50.50.10.30.40.10.53.31.21.0
    *PSR groupavg.(StDev)
    n = 17 levels
    0.40.10.20.20.10.20.80.30.2
    (0.1)(0.1)(0.1)(0.1)(0.1)(0.2)(0.4)(0.3)(0.1)
    Lateral plate/screw
      AInferior endplate at L3-L40.10.10.13.20.51.80.50.20.2
      Inferior endplate at L4-L50.10.00.10.20.00.20.40.10.3
      Superior endplate at L4-L50.30.10.70.40.82.12.11.50.5
      BInferior endplate at L3-L40.50.10.00.20.10.00.70.20.2
    *ALP groupavg.(StDev)
    n = 14 levels
    0.30.10.20.20.20.20.80.20.4
    (0.2)(0.1)(0.4)(0.1)(0.4)(0.2)(1.0)(0.3)(0.4)
    • Abbreviations: avg., average; StDev, standard deviation. Lateral cage translations were measured during cyclic loading along theanterior-posterior (A-P), medial-lateral (M-L), and inferior-superior (I-S) axes for each loading mode.

    • ↵* Average cage translations for the respective treatments (PSR and ALP) inspecimens with intact endplates.

    • View popup
    Table 4

    Radiographic indirect decompression results for pedicle screw/rod and anterior-lateral plate specimens with endplate fracture subsequent to lateral cage implantation

    Endplate fracture location and levelRadiographic metric
    Posterior disc height (DH, mm)Foraminal area (FA, mm2)Canal area (CA, mm2)
    Intact XLIF Percentage increase (%)Intact XLIF Percentage increase (%)Intact XLIF Percentage increase (%)
    Pedicle screw/rod Inferior endplate at L4-L57.09.738.1112.0154.037.5108.0161.049.1
    *PSR group avg. *PSR group avg. *PSR group avg.
    n = 17 levels61.8n = 17 levels62.0n = 17 levels34.5
    Lateral plate/screw
      AInferior endplate at L3-L46.04.0−33.3100.592.0−8.5177.0183.03.4
      Inertior endplate at L4-L55.07.040.0117.5170.044.7162.5205.526.5
      Superior endplate at L4-L55.07.753.4152.3226.048.4131.0189.044.3
      BInferior endplate at L3-L48.013.062.5119.5193.061.5128.0173.535.5
    *ALP group avg. *ALP group avg. *ALP group avg.
    n = 14 levels37.6n = 14 levels43.4n = 14 levels38.1
    • Abbreviations: avg., average; XLIF, extreme lateral interbody fusion.

    • ↵* Average radiographic measures for the respective treatments (PSR and ALP) in specimen swith intact endplates.

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1 Jan 2013
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Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study
Brandon G. Santoni, Gerald E. Alexander, Aniruddh Nayak, Andres Cabezas, German A. Marulanda, Ryan Murtagh, Antonio E. Castellvi
International Journal of Spine Surgery Jan 2013, 7 e101-e108; DOI: 10.1016/j.ijsp.2013.09.001

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Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study
Brandon G. Santoni, Gerald E. Alexander, Aniruddh Nayak, Andres Cabezas, German A. Marulanda, Ryan Murtagh, Antonio E. Castellvi
International Journal of Spine Surgery Jan 2013, 7 e101-e108; DOI: 10.1016/j.ijsp.2013.09.001
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Keywords

  • lumbar interbody fusion
  • lateral transpsoas approach
  • Endplate fracture
  • indirect decompression
  • stability

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