title: A novel lateral lumbar integrated plate-spacer interbody implant: in vitro biomechanical analysis.
abstract: BACKGROUND
  Lateral spacers (LSs) are the standard of care for a lateral lumbar interbody fusion. However, various types of fixation, such as bilateral pedicle screws (BPSs), unilateral pedicle screws (UPSs), bilateral facet screws (BFSs), and lateral plates (LPs) have been reported to increase the stability of LSs. The biomechanics of a novel lateral interbody implant, which is an interbody spacer with an integrated plate and two bone screws (lateral integrated plate-spacer [IPS-L]), has not been investigated yet.
  
  
  OBJECTIVE
  To compare the biomechanical stability of IPS-L and LS with and without supplemental instrumentation.
  
  
  METHODS
  Human lumbar cadaveric study evaluating the biomechanical stability of an IPS-L.
  
  
  METHODS
  Each of the six (L2-L5) spines was sequentially tested in intact; IPS-L; IPS-L+UPS; IPS-L+BPS; IPS-L+BFS; LS+BFS; LS+UPS; LS+BPS; LS; and LS+LP, using a load-control protocol in which a ±8 Nm moment was applied, for three cycles each, in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Data results were obtained from the third cycle.
  
  
  RESULTS
  The IPS-L construct significantly reduced the range of motion (ROM) by 75% in FE, 70% in LB, and 57% in AR, compared with intact. Lateral integrated plate-spacer demonstrated similar biomechanical stability as LS+LP, and higher stability than the LS-alone construct, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  The IPS-L evaluated in the present study demonstrated equivalent biomechanical stability compared with standard lateral interbody fusion constructs. The addition of BPSs to the IPS-L showed significant reduction in ROM in FE, and the addition of BFSs showed significant reduction in ROM in FE and AR, compared with the integrated plate-spacer alone construct. The IPS-L with supplemental fixation may be a viable option for lateral interbody fusion. Long-term clinical studies are further required to confirm these results.
authors.affiliation: Long Island Spine Specialists PC, 763 Larkfield Rd, 2nd Floor, Commack, NY 11725, USA.
authors.forename: Sushil
authors.initials: S
authors.lastname: Basra
authors.affiliation: Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Bucklen
authors.affiliation: Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Muzumdar
authors.affiliation: Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA.
authors.forename: Saif
authors.initials: S
authors.lastname: Khalil
authors.affiliation: Research and Development, Globus Medical, Inc., Valley Forge Business Center, 2560 General Armistead Ave., Audubon, PA 19403, USA. Electronic address: manasa.gudipally@gmail.com.
authors.forename: Manasa
authors.initials: M
authors.lastname: Gudipally
mesh_terms: D001696:Biomechanical Phenomena / Q000502:physiology; D001860:Bone Plates; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D065289:Pedicle Screws; D016059:Range of Motion, Articular / Q000502:physiology; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013131:Spine / Q000601:surgery
keywords: Fusion; Integrated; Interbody; Lumbar; Novel; Plate; Spacer