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Changes in neuroforaminal height with 2 level axial presacral lumbar interbody fusion at L4-S1.

Marawar S, Ordway N, Jung J, Sun M - Int J Spine Surg (2014)

Bottom Line: When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver.At least 2 full rotations of the screw driver were achieved in all cadavers.The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Surgery, SUNY Upstate Medical University.

ABSTRACT

Background: The objective was to examine the changes in neuroforaminal height at L4-L5 and L5-S1 after insertion and graduated foraminal distraction using the 2 level transsacral implant in a cadaveric model.

Methods: Discectomy and transsacral instrumentation was performed in six fresh human cadavers at L4-S1. The neuroforaminal height was measured at L4-L5 and L5-S1 before and after insertion of the implant and then at each stage of manual distraction.

Results: Mean L4-5 neuroforaminal height increased from 18.2 ± 3.1mm to 20.3± 2.9mm (11%) on the left and from 18.8±2.8mm to 20.6± 2.3mm (12%) on the right (P<0.05). Mean L5-S1 neuroforaminal height increased from 15.7±3.0mm to 18.4 ±2.8mm (17%) on the left and from 15.6 ±2.1mm to 18.3 ±1.8mm (17%) on the right (P<0.05). When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver. At least 2 full rotations of the screw driver were achieved in all cadavers.

Conclusions: The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope. During the initial process, manual control of disc space distraction predictably correlated with the increase in the neuroforaminal height to a maximum. However, further research is needed to look at variables affecting disc space pliability, implant subsidence, in vivo application, and clinical benefit of this procedure.

No MeSH data available.


Related in: MedlinePlus

Surgical preparation of the working channel from L4-S1 disc space and the L4-5 disc space preparation prior to insertion of the implant.
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Figure 0002: Surgical preparation of the working channel from L4-S1 disc space and the L4-5 disc space preparation prior to insertion of the implant.

Mentions: The insertion of the transsacral implant was performed in a standard manner under fluoroscopic control by a spine surgeon trained in performing the procedure. The technique for insertion involved passing in a series of dilators over a guide wire inserted in the L4-S1 disc spaces. A series of reamers are passed over the guide wire to establish a working channel into the disc spaces. A thorough discectomy is performed through the working channel using radial disc debulkers, disc extractors and end plate rasps (Figure 2).


Changes in neuroforaminal height with 2 level axial presacral lumbar interbody fusion at L4-S1.

Marawar S, Ordway N, Jung J, Sun M - Int J Spine Surg (2014)

Surgical preparation of the working channel from L4-S1 disc space and the L4-5 disc space preparation prior to insertion of the implant.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325505&req=5

Figure 0002: Surgical preparation of the working channel from L4-S1 disc space and the L4-5 disc space preparation prior to insertion of the implant.
Mentions: The insertion of the transsacral implant was performed in a standard manner under fluoroscopic control by a spine surgeon trained in performing the procedure. The technique for insertion involved passing in a series of dilators over a guide wire inserted in the L4-S1 disc spaces. A series of reamers are passed over the guide wire to establish a working channel into the disc spaces. A thorough discectomy is performed through the working channel using radial disc debulkers, disc extractors and end plate rasps (Figure 2).

Bottom Line: When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver.At least 2 full rotations of the screw driver were achieved in all cadavers.The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Surgery, SUNY Upstate Medical University.

ABSTRACT

Background: The objective was to examine the changes in neuroforaminal height at L4-L5 and L5-S1 after insertion and graduated foraminal distraction using the 2 level transsacral implant in a cadaveric model.

Methods: Discectomy and transsacral instrumentation was performed in six fresh human cadavers at L4-S1. The neuroforaminal height was measured at L4-L5 and L5-S1 before and after insertion of the implant and then at each stage of manual distraction.

Results: Mean L4-5 neuroforaminal height increased from 18.2 ± 3.1mm to 20.3± 2.9mm (11%) on the left and from 18.8±2.8mm to 20.6± 2.3mm (12%) on the right (P<0.05). Mean L5-S1 neuroforaminal height increased from 15.7±3.0mm to 18.4 ±2.8mm (17%) on the left and from 15.6 ±2.1mm to 18.3 ±1.8mm (17%) on the right (P<0.05). When the neuroforaminal height was plotted against amount of rotation of the screw driver it was found that the neuroforaminal height at L5-S1 increased by 1mm on average for every complete revolution of the screw driver. At least 2 full rotations of the screw driver were achieved in all cadavers.

Conclusions: The transsacral screw construct distracted the disc space and neuroforaminal height in a cadaveric spine model without soft tissue envelope. During the initial process, manual control of disc space distraction predictably correlated with the increase in the neuroforaminal height to a maximum. However, further research is needed to look at variables affecting disc space pliability, implant subsidence, in vivo application, and clinical benefit of this procedure.

No MeSH data available.


Related in: MedlinePlus