Stability of Transforaminal Lumbar Interbody Fusion in the Setting of Retained Facets and Posterior Fixation Using Transfacet or Standard Pedicle Screws

Spinal research by Dr. Kingsley R. Chin of the LESS Institute

Scientific Paper

Chin KR1Reis MT2Reyes PM2Newcomb AG2Neagoe A2Gabriel JP3Sung RD4Crawford NR2.

Interested medical professionals can read through the full paper, as published in the Spine Journal, here.

Background Concept

The transforaminal lumbar interbody fusion (TLIF) technique supplements posterior instrumented lumbar spine fusion and has been tested with different types of screw fixation for stabilization. Transforaminal lumbar interbody fusion is usually placed through a unilateral foraminal approach after unilateral facetectomy, although extraforaminal entry allows the facet to be spared.

Purpose

To characterize the biomechanics of L4-L5 lumbar motion segments instrumented with bilateral transfacet pedicle screw (TFPS) fixation versus bilateral pedicle screw-rod (PSR) fixation in the setting of intact facets and native disc or after discectomy and extraforaminal placement of a TLIF technology graft.

Study Design

Human cadaveric lumbar spine segments were biomechanically tested in vitro to provide a nonpaired comparison of four configurations of posterior and interbody instrumentation.

Methods

Fourteen human cadaveric spine specimens (T12-S1) underwent standard pure moment flexibility tests with intact L4-L5 disc and facets. Seven were studied with intact discs, after TFPS fixation, and then with TLIF and TFPS fixation. The others were studied with intact discs, after PSR fixation, and then combined with extraforaminally placed TLIF. Loads were applied about anatomic axes to induce flexion-extension, lateral bending, and axial rotation. Three-dimensional specimen motion in response to applied loads during flexibility tests was determined. A nonpaired comparison of the four configurations of posterior and interbody instrumentation was made.

Results

Transfacet pedicle screw and PSR, with or without TLIF, significantly reduced range of motion during all directions of loading. Transfacet pedicle screw provided greater stability than PSR in all directions of motion except lateral bending. In flexion, TFPS was more stable than PSR (p=.042). A TLIF device provided less stability than the intact disc in constructs with TFPS and PSR.

Conclusions

These results suggest that fixation at L4-L5 with TFPS is a promising alternative to PSR, with or without TLIF. A TLIF device was less stable than the native disc with both methods of instrumentation presumably because of a fulcrum effect from a relatively small footplate. Additional interbody support may be considered for improved biomechanics with TLIF.

About Author Dr. Kingsley R. Chin

Dr. Kingsley R. Chin, founder of philosophy and practice of The LES Society and The LESS Institute
Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author and Citation Details

Authors

Chin KR1Reis MT2Reyes PM2Newcomb AG2Neagoe A2Gabriel JP3Sung RD4Crawford NR2.

Author information

  1. Charles E. Schmidt College of Medicine at Florida Atlantic University, 777 Glades Rd, Building 71, Boca Raton, FL 33431, USA; Department of Orthopaedic Surgery, The LES Spine Institute, 1100 W. Oakland Park Blvd., Suite #3, Fort Lauderdale, FL 33311, USA. Electronic address: kingsleychin@imissurgery.com.
  2. Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013, USA.
  3. Department of Orthopedics, Grant Medical Center, 111 South Grant Ave, Columbus, OH 43215, USA.
  4. The Spine Center at The Colorado Springs Orthopaedic Group, 3010 North Circle Dr, Suite 200, Colorado Springs, CO 80909, USA.

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