Primary spinal segment stability with a stand-alone cage: in vitro evaluation of a successful goat model.
BACKGROUND
Interbody cages have been developed to restore disk height and to increase stability of the spinal segment, and thereby enhance fusion. However, they often prove inadequate as a stand-alone device. It is unknown how much primary stability is required to facilitate fusion. In various goat studies, we have obtained spinal fusion routinely with a stand-alone cage device. However, data covering the mechanical conditions under which these fusions have been obtained are lacking. In this study, we addressed the issue of primary stability.


METHODS
We used an established goat model for spinal fusion in vitro. 48 native lumbar spine segments were mechanically tested in flexion/extension, axial torsion (left/right), anterior/posterior shear, and left/right lateral bending. Then all segments were provided with a titanium cage using the exact surgical procedure of our earlier in vivo studies, and the mechanical tests were repeated. Under shear force and axial torsion, a significant loss of stiffness was seen in the operated segments as compared to nonoperated controls. No increase in stiffness was found in any of the loading directions.


CONCLUSIONS
Cage implantation in a lumbar spinal segment does not increase immediate postoperative stability as compared to the native segment in this goat model. This is attributable to both the annular damage during cage implantation and the subsequent loss of segment height. Yet previous in vivo studies using this goat model have generally shown fusion. This implies that high primary segment stability is not required for fusion or, alternatively, that the tested range of motion of the spinal segment in vitro does not occur at these magnitudes in vivo.
Krijnen
Matthijs R
MR
Department of Physics and Medical Technology, VU University Medical Center, The Netherlands Skeletal Tissue Engineering Group Amsterdam (STEGA), Amsterdam, The Netherlands.
Mensch
Daniel
D
van Dieen
Jaap H
JH
Wuisman
Paul I
PI
Smit
Theo H
TH
D000818:Animals; D001696:Biomechanical Phenomena; D005260:Female; D006041:Goats; D066298:In Vitro Techniques; D008159:Lumbar Vertebrae / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013526:Surgical Mesh; D014025:Titanium
D014025:Titanium