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Two-piece ALIF cage optimizes the bone-implant interface in a 360° setting.

Hans-Joachim Wilke1, David Volkheimer2, Bruce Robie3

  • 1Trauma Research Centre Ulm, Institute of Orthopaedic Research and Biomechanics, University Hospital Ulm, Helmholtzstr. 14, 89081, Ulm, Germany. hans-joachim.wilke@uni-ulm.de.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|March 2, 2017
PubMed
Summary

A novel two-piece anterior lumbar interbody fusion (ALIF) cage reduces bone-implant motion compared to traditional one-piece cages. This advancement in spinal fusion implants enhances stability without compromising biomechanical integrity.

Keywords:
ALIFBiomechanicsIn vitroLumbar spineSagittal balance

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Area of Science:

  • Spine biomechanics
  • Orthopedic implant design
  • Spinal fusion research

Background:

  • Cage subsidence and loss of balance correction are significant complications in spinal fusion.
  • Implant design is a critical factor influencing multifactorial subsidence complications.
  • Conventional one-piece anterior lumbar interbody fusion (ALIF) cages present limitations.

Purpose of the Study:

  • To compare the rigidity and bone-implant relative motion of spinal segments treated with a novel two-piece ALIF cage versus a conventional one-piece ALIF cage.
  • To evaluate the in situ adaptability and lordotic capacity of the two-piece ALIF cage design.

Main Methods:

  • Seven human cadaveric lumbosacral (L3-S1) specimens were tested under pure moments (±7.5 Nm) in three motion directions.
  • Specimens were analyzed in intact, one-piece ALIF cage, and two-piece ALIF cage configurations, all with pedicle screw instrumentation.
  • Bone-implant interface motion was assessed using fluoroscopic video capture and 3D optical motion tracking.

Main Results:

  • The two-piece ALIF cage demonstrated significantly less motion at the implant-endplate interface (1.0° ± 0.6°) compared to the one-piece cage (4.2° ± 1.7°) during flexion/extension.
  • No significant differences in overall segment rigidity were observed between the one-piece and two-piece cage constructs.
  • Both ALIF cage configurations significantly reduced the range of motion compared to the intact condition (p < 0.05).

Conclusions:

  • The two-piece ALIF cage design effectively reduces relative motion at the bone-implant interface.
  • This reduction in motion is achieved without compromising spinal segment stability.
  • The two-piece cage represents an advancement over traditional one-piece ALIF cages for spinal fusion.