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Related Experiment Video

Updated: Jul 27, 2026

A Novel Vertebral Stabilization Method for Producing Contusive Spinal Cord Injury

A Novel Vertebral Stabilization Method for Producing Contusive Spinal Cord Injury

Published on: January 5, 2015

A modular cage may prevent endplate damage and improve spinal deformity correction.

Jan Ulrich Jansen¹, Vincenza Sciortino², Frank Heuer³

¹Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, University Hospital Ulm, Helmholtzstraße 14, Ulm 89081, Germany.

Clinical Biomechanics (Bristol, Avon)

|April 26, 2025

Summary

Modular cages for anterior lumbar interbody fusion reduce bone fragmentation and increase lordosis compared to monobloc cages. This may improve patient sagittal balance restoration.

Keywords:

Endplate damage Interbody fusion Sagittal balance correction Spinal cage μCT

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Published on: November 8, 2024

Area of Science:

Spinal Surgery
Biomechanics
Orthopedic Implants

Background:

Anterior lumbar interbody fusion (ALIF) commonly uses monobloc cages inserted with impact.
Three-part modular cages are a newer alternative designed to reduce impact forces and endplate damage.
Modular cages aim to improve lordosis correction during ALIF procedures.

Purpose of the Study:

To compare the endplate damage and lordosis angle achieved by monobloc versus modular stand-alone cages in ALIF.
To evaluate the impact of cage type on bone fragmentation and sagittal balance restoration.
To assess the efficacy of AI-based lordosis angle measurements in evaluating surgical outcomes.

Main Methods:

Human lumbar motion segments (L2-L3, L4-L5) were used for in vitro implantation simulation (n=12).
Procedures included discectomy followed by implantation of either monobloc or modular cages.
Macroscopic imaging, microcomputed tomography (micro-CT), and AI-based lordosis measurements were performed to assess endplate damage and angle correction.

Main Results:

Both cage types caused mid-level damage (29%), but modular cages resulted in more low-damage instances (13% vs. 17% for monobloc).
Bone fragmentation was significantly higher in the monobloc group (71%) compared to the modular group.
Modular cages achieved a greater median lordosis of 21.3° versus 19.5° for monobloc cages, a 34% increase.

Conclusions:

Endplate damage is present with both monobloc and modular ALIF cages, but modular designs reduce severe bone fragmentation.
Bone fragmentation negatively impacts the achievable lordosis angle, potentially hindering sagittal balance restoration.
Newer implantation techniques and modular cage designs are crucial for optimizing lordosis and patient outcomes in ALIF.