title: Biomechanical effect of transforaminal lumbar interbody fusion and axial interbody threaded rod on range of motion and S1 screw loading in a destabilized L5-S1 spondylolisthesis model.
abstract: METHODS
  A cadaveric lumbosacral spondylolytic spondylolisthesis model was used to evaluate the biomechanical function of 2 different interbody spacers.
  
  
  OBJECTIVE
  To analyze and compare the reduction in pedicle screw strain and spine range of motion (ROM) between transforaminal lumbar interbody fusion (TLIF) and an axial interbody threaded rod (AxialITR) in a destabilized L5-S1 spondylolisthesis model.
  
  
  BACKGROUND
  Symptomatic spondylolytic spondylolisthesis is often treated with posterior instrumented fusion augmented by a variety of different interbody devices. Interbody spacers rely primarily on posterior instrumentation to stabilize the spine during fusion, but there may be advantages to the more rigid support offered by an anterior threaded rod.
  
  
  METHODS
  Pure-moment flexibility testing was performed on L3-S1 cadaveric specimens in 4 conditions: (1) Intact, (2) L5-S1 pedicle screws (PS) + L5-S1 disc destabilization (DDS), (3) TLIF at L5-S1 + PS + DDS, and (4) AxialITR at L5-S1 + PS + DDS. Specimens were destabilized by performing a complete denucleation at L5-S1 and sectioning two-thirds of the annulus' width from anterior to posterior. The S1 PSs were instrumented with strain gauges to measure screw-bending moments and ROM was quantified with a noncontact camera system.
  
  
  RESULTS
  S1 screw strains were highest with PS but were significantly reduced by 73% in flexion and 31% in extension with TLIF (P ≤ 0.004). AxialITR significantly reduced strain by 78% in flexion and 81% in extension (P ≤ 0.001). ROM was smallest with AxialITR in each test direction at 1.7 ± 1.8° in flexion-extension, 1.6 ± 0.9° in lateral bending and 1.3 ± 0.8° in torsion.
  
  
  CONCLUSIONS
  This study demonstrated that ROM and S1 screw-bending moments were reduced with the use of AxialITR and TLIF. Although the TLIF and AxialITR both reduced strains and motion, the AxialITR provided a significant reduction in extension strain when compared with TLIF.
  
  
  METHODS
  N/A.
authors.affiliation: *Southern New Hampshire Medical Center, Nashua, NH †Cleveland Clinic, Cleveland, OH ‡OrthoKinetic Technologies, Southport, NC §Excelen Center for Bone and Joint Research, Minneapolis, MN; and ¶TranS1, Wilmington, NC.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Fleischer
authors.forename: David
authors.initials: D
authors.lastname: Hart
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Ferrara
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Freeman
authors.forename: Eugene E
authors.initials: EE
authors.lastname: Avidano
mesh_terms: D001696:Biomechanical Phenomena / Q000502:physiology; D001863:Bone Screws; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000502:physiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012447:Sacrum / Q000473:pathology / Q000502:physiology* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000473:pathology / Q000601:surgery; D016474:Weight-Bearing / Q000502:physiology