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

Abstract

Introduction: Clinical research has documented that cage subsidence and the loss of balance correction is a significant complication related to spinal fusion. Subsidence is a multifactorial complication, where implant design is one important element. The aim of the study is to compare the rigidity and bone-implant relative motion of segments treated with either a conventional one-piece ALIF cage versus a two-piece ALIF cage, which adapts in situ and permits 7°-21° of lordosis.

Methods: Seven lumbosacral (L3-S1) human cadaver specimens were tested in a universal spine tester in the intact condition, the specimens instrumented with a two-piece ALIF cage (Statur^®-L, FBC Device, Denmark) and a one-piece ALIF cage (Pezo™-A, Ulrich GmbH & Co. KG., Germany), both supplemented with a pedicle screw system using pure moments of ±7.5 Nm in three principal motion directions. For assessment of the bone-implant interface, fluoroscopic videos were captured during motion and 3D motion was measured using an optical motion capturing system.

Results: Significantly less motion at the implant-endplate interface was found for the two-piece cage (1.0° ± 0.6°) in comparison to the one-piece cage (4.2° ± 1.7°) in flexion/extension. No significant differences in segment rigidity were found between the one-piece and two-piece cages in the 360° setup, while both configurations significantly reduced the range of motion compared to the intact condition (p < 0.05).

Conclusion: In comparison to the traditional one-piece ALIF cages, the two-piece cage concept reduced the relative motion at the bone-implant interface without compromising stability.

Keywords: ALIF; Biomechanics; In vitro; Lumbar spine; Sagittal balance.