title: Segmental stability and compressive strength of posterior lumbar interbody fusion implants.
abstract: METHODS
  Human cadaveric study on initial segmental stability and compressive strength of posterior lumbar interbody fusion implants.
  
  
  OBJECTIVE
  To compare the initial segmental stability and compressive strength of a posterior lumbar interbody fusion construct using a new cortical bone spacer machined from allograft to that of titanium threaded and nonthreaded posterior lumbar interbody fusion cages, tested as stand-alone and with supplemental pedicle screw fixation.
  
  
  BACKGROUND
  Cages were introduced to overcome the limitations of conventional allografts. Radiodense cage materials impede radiographic assessment of the fusion, however, and may cause stress shielding of the graft.
  
  
  METHODS
  Multisegmental specimens were tested intact, with posterior lumbar interbody fusion implants inserted into the L4/L5 interbody space and with supplemental pedicle screw fixation. Three posterior lumbar interbody fusion implant constructs (Ray Threaded Fusion Cage, Contact Fusion Cage, and PLIF Allograft Spacer) were tested nondestructively in axial rotation, flexion-extension, and lateral bending. The implant-specimen constructs then were isolated and compressed to failure. Changes in the neutral zone, range of motion, yield strength, and ultimate compressive strength were analyzed.
  
  
  RESULTS
  None of the stand-alone implant constructs reduced the neutral zone. Supplemental pedicle screw fixation decreased the neutral zone in flexion-extension and lateral bending. Stand-alone implant constructs decreased the range of motion in flexion and lateral bending. Differences in the range of motion between stand-alone cage constructs were found in flexion and extension (marginally significant). Supplemental posterior fixation further decreased the range of motion in all loading directions with no differences between implant constructs. The Contact Fusion Cage and PLIF Allograft Spacer constructs had a higher ultimate compressive strength than the Ray Threaded Fusion Cage.
  
  
  CONCLUSIONS
  The biomechanical data did not suggest any implant construct to behave superiorly either as a stand-alone or with supplemental posterior fixation. The PLIF Allograph Spacer is biomechanically equivalent to titanium cages but is devoid of the deficiencies associated with other cage technologies. Therefore, the PLIF Allograft Spacer is a valid alternative to conventional cages.
authors.affiliation: Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Tsantrizos
authors.forename: H G
authors.initials: HG
authors.lastname: Baramki
authors.forename: S
authors.initials: S
authors.lastname: Zeidman
authors.forename: T
authors.initials: T
authors.lastname: Steffen
mesh_terms: D001863:Bone Screws; D002102:Cadaver; D019245:Compressive Strength / Q000502:physiology; D004867:Equipment Design; D006801:Humans; D016268:Internal Fixators; D007403:Intervertebral Disc / Q000502:physiology* / Q000601:surgery; D007593:Joint Instability / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000502:physiology* / Q000601:surgery; D008875:Middle Aged; D008954:Models, Biological; D016059:Range of Motion, Articular; D012399:Rotation; D013123:Spinal Fusion / Q000295:instrumentation*; D013314:Stress, Mechanical