title: Biomechanical comparison of anterolateral plate, lateral plate, and pedicle screws-rods for enhancing anterolateral lumbar interbody cage stabilization.
abstract: METHODS
  A repeated measures in vitro flexibility experiment was performed in calf spines.
  
  
  OBJECTIVE
  To determine the biomechanical differences among three techniques for augmenting stability of an anterolateral lumbar threaded interbody cage.
  
  
  BACKGROUND
  Stand-alone interbody cages are known to inadequately stabilize the spine. Surgeons often add supplementary instrumentation for a more stable construct.
  
  
  METHODS
  Six L2-L5 calf spines (L3-L4 level instrumented) were tested: 1) intact; 2) with a single anterolateral interbody cage; 3) with cage plus anterolateral plating; 4) with cage plus lateral plating; and 5) with cage plus pedicle screw fixation. Specimens were loaded in each anatomic plane quasistatically (maximum 5.0 Nm). Angular motion was measured stereophotogrammetrically.
  
  
  RESULTS
  The stand-alone interbody cage allowed significantly less range of motion than normal during all loading modes except axial rotation. Addition of pedicle screws-rods, anterolateral plate, or lateral plate significantly further reduced range of motion in all planes. Pedicle screws slightly outperformed the anterolateral plate during extension and lateral bending and slightly outperformed the lateral plate during flexion, extension, and left axial rotation (range of motion differences <0.65 degrees, P < 0.05). The anterolateral plate outperformed the lateral plate during flexion and extension, whereas the lateral plate outperformed the anterolateral plate during lateral bending (range of motion difference <0.57 degrees, P < 0.05).
  
  
  CONCLUSIONS
  Anterolateral or lateral lumbar plating increases stability significantly compared to stand-alone interbody cage fixation. These findings support anterolateral or lateral plate fixation as a potential clinical alternative to pedicle screws-rods in this role and may obviate the need for combined anterior and posterior approaches when spinal instability exists.
authors.affiliation: Spinal Biomechanics Research Laboratory, Barrow Neurological Institute, Phoenix, Arizona 85013, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozkus
authors.forename: Robert H
authors.initials: RH
authors.lastname: Chamberlain
authors.forename: Luis E
authors.initials: LE
authors.lastname: Perez Garza
authors.forename: Neil R
authors.initials: NR
authors.lastname: Crawford
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Dickman
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D002417:Cattle; D004867:Equipment Design; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D009038:Motion; D010780:Photogrammetry