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Cyclic testing of standalone ALIF versus TLIF in lumbosacral spines of low bone mineral density: an ex vivo biomechanical study

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Abstract

Purpose

Screwed anterior lumbar interbody fusion (SALIF) alleviates the need for supplemental posterior fixation leading to reduction of perioperative morbidity. Specifically, elderly and multimorbid patients would benefit from shorter operative time and faster recovery but tend to have low bone mineral density (BMD). The current study aimed to compare loosening, defined as increase of ROM and NZ, of SALIF versus transforaminal lumbar interbody fusion (TLIF) under cyclic loading in cadaveric spines with reduced BMD.

Methods

Twelve human spines (L4–S2; 6 male 6 female donors; age 70.6 ± 19.6; trabecular BMD of L5 84.2 ± 24.4 mgHA/cm3, range 51–119 mgHA/cm3) were assigned to two groups. SALIF or TLIF were instrumented at L5/S1. Range of motion (ROM) and neutral zone (NZ) were assessed before and after axial cyclic loading (0–1150 N, 2000 cycles, 0.5 Hz) in flexion–extension (Flex–Ext), lateral bending, (LB), axial rotation (AR).

Results

ROM of the SALIF specimens increased significantly in all loading directions (p ≤ 0.041), except for left AR (p = 0.053), whereas for TLIF it increased significantly in left LB (p = 0.033) and Flex (p = 0.015). NZ of SALIF showed increase in Flex–Ext and LB, whereas NZ of TLIF did not increase significantly in any motion direction.

Conclusions

Axial compression loading caused loosening of SALIF in Flex–Ext and LB, but not TLIF at L5/S1 in low BMD specimens. Nevertheless, Post-cyclic ROM and NZ of SALIF is comparable to TLIF. This suggests that, neither construct is optimal for the use in patients with reduced BMD.

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Acknowledgements

Part of this work was acknowledged by the Best Podium Presentation Award EORS 2023 31st Annual Meeting of the European Orthopaedic Research Society, Porto, Portugal.

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Authors and Affiliations

  1. Biomedical Department, AO Research Institute Davos, Davos, Switzerland

    Alina Jacob, Maximilian Heumann, Ivan Zderic, Peter Varga, R Geoff Richards & Boyko Gueorguiev

  2. Department of Spine Surgery, Schulthess Clinic, Zurich, Switzerland

    Alina Jacob, Daniel Haschtmann, Tamas Fekete & Markus Loibl

  3. Faculty of Medicine Sibiu, Lucian Blaga University, Sibiu, Romania

    Nicolas Ion & Bogdan Bocea

  4. Department of Neurosurgery, University of Ulm, Ulm, Germany

    Christian Rainer Wirtz

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  1. Alina Jacob
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Jacob, A., Heumann, M., Zderic, I. et al. Cyclic testing of standalone ALIF versus TLIF in lumbosacral spines of low bone mineral density: an ex vivo biomechanical study. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08391-7

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