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• W4386042043 abstract "BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) currently accounts for 16% of lumbar interbody procedures and is becoming increasingly popular. ALIFs may exist as standalone constructs, stabilized by plate fixation, interference screws or integrated screws, depending on patient-specific factors including bone quality. The use of integrated screws is attractive to surgeons because of the ease of implantation and no additional profile. However, the number of screws necessary for safe and stable implantation in various bone densities is not yet fully understood. PURPOSE To evaluate the biomechanical stability of standalone anterior lumbar interbody fixation with regards to the number of screws implanted, length of screws and bone density in a bone surrogate model. A secondary aim was to determine if use of longer screws can compensate for fewer screws implanted. STUDY DESIGN/SETTING The study is a controlled laboratory study performed through mechanical testing of bone surrogates. OUTCOME MEASURES Construct failure load and stiffness were measured/calculated. METHODS Three bone models with densities of 10, 15, and 20 pounds per cubic foot (PCF) were chosen as surrogates of vertebral bodies, representing osteoporotic, normal, and higher than normal bone densities. The segments were instrumented using the Z-Link Lumbar anterior interbody system and either two, three or four 4.5mm diameter x 20mm or 25 mm length integrated screws (Zavation, LLC, Flowood, MS). Mechanical testing was performed through two rigid fixtures connected to the Instron 8872 (Norwood, MA). The fixtures were displaced axially at 10mm/min until failure of the construct was reached, defined as a 90% reduction of applied load. Load-displacement data was acquired at a frequency of 100 Hz and in 1N increments. Peak force values were recorded as failure loads. The stiffness of each construct was measured as the linear regression slope of the load vs displacement data to peak load. RESULTS Fifty-four experiments were performed. Failure loads ranged from 64.98N±8.29 for the low-density surrogate implanted with only two screws to the value of 401.11N±12.25 for the highest density bone surrogate with four screws. The failure load of the construct was significantly influenced by the number of screws (p<0.01), screw length (p=0.01), as well as the density of the bone surrogates (p0.05). Using three 25mm length screws compared four 20mm length screws resulted in a recovery of the construct stiffness (p>0.05) but was beneficial (p>0.05) only for the intermediate density surrogate (PCF 15). CONCLUSIONS Anterior lumbar interbody fixation is significantly influenced by the number and length of the integrated screws implanted, as well as the density in a bone surrogate model. Under certain conditions, fixation with fewer, longer screws can impart comparable stability of the interbody as an implant that is secured with more screws. The results of this biomechanical study can be translated for surgeons in the clinical setting who commonly perform ALIF procedures and may require salvage fixation. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Anterior lumbar interbody fusion (ALIF) currently accounts for 16% of lumbar interbody procedures and is becoming increasingly popular. ALIFs may exist as standalone constructs, stabilized by plate fixation, interference screws or integrated screws, depending on patient-specific factors including bone quality. The use of integrated screws is attractive to surgeons because of the ease of implantation and no additional profile. However, the number of screws necessary for safe and stable implantation in various bone densities is not yet fully understood. To evaluate the biomechanical stability of standalone anterior lumbar interbody fixation with regards to the number of screws implanted, length of screws and bone density in a bone surrogate model. A secondary aim was to determine if use of longer screws can compensate for fewer screws implanted. The study is a controlled laboratory study performed through mechanical testing of bone surrogates. Construct failure load and stiffness were measured/calculated. Three bone models with densities of 10, 15, and 20 pounds per cubic foot (PCF) were chosen as surrogates of vertebral bodies, representing osteoporotic, normal, and higher than normal bone densities. The segments were instrumented using the Z-Link Lumbar anterior interbody system and either two, three or four 4.5mm diameter x 20mm or 25 mm length integrated screws (Zavation, LLC, Flowood, MS). Mechanical testing was performed through two rigid fixtures connected to the Instron 8872 (Norwood, MA). The fixtures were displaced axially at 10mm/min until failure of the construct was reached, defined as a 90% reduction of applied load. Load-displacement data was acquired at a frequency of 100 Hz and in 1N increments. Peak force values were recorded as failure loads. The stiffness of each construct was measured as the linear regression slope of the load vs displacement data to peak load. Fifty-four experiments were performed. Failure loads ranged from 64.98N±8.29 for the low-density surrogate implanted with only two screws to the value of 401.11N±12.25 for the highest density bone surrogate with four screws. The failure load of the construct was significantly influenced by the number of screws (p<0.01), screw length (p=0.01), as well as the density of the bone surrogates (p0.05). Using three 25mm length screws compared four 20mm length screws resulted in a recovery of the construct stiffness (p>0.05) but was beneficial (p>0.05) only for the intermediate density surrogate (PCF 15). Anterior lumbar interbody fixation is significantly influenced by the number and length of the integrated screws implanted, as well as the density in a bone surrogate model. Under certain conditions, fixation with fewer, longer screws can impart comparable stability of the interbody as an implant that is secured with more screws. The results of this biomechanical study can be translated for surgeons in the clinical setting who commonly perform ALIF procedures and may require salvage fixation." @default.
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• W4386042043 date "2023-09-01" @default.
• W4386042043 modified "2023-10-09" @default.
• W4386042043 title "116. Minimal number and length of screws needed for stable standalone anterior lumbar interbody fixation: a bone surrogate study" @default.
• W4386042043 doi "https://doi.org/10.1016/j.spinee.2023.06.168" @default.
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