Revision of transforaminal lumbar interbody fusion using anterior lumbar interbody fusion: a biomechanical study in nonosteoporotic bone

Abstract

Transforaminal lumbar interbody fusion (TLIF) is a popular fusion technique for treating chronic low-back pain. In cases of interbody nonfusion, revision techniques for TLIF include anterior lumbar interbody fusion (ALIF) approaches. Biomechanical data of the revision techniques are not available. The purpose of this study was to compare the immediate construct stability, in terms of range of motion (ROM) and neutral zone (NZ), of a revision ALIF procedure for an unsuccessful TLIF. An in vitro biomechanical comparison of TLIF and its ALIF revision procedure was conducted on cadaveric nonosteoporotic human spine segments. Twelve cadaveric lumbar motion segments with normal bone mineral density were loaded in unconstrained axial torsion, lateral bending, and flexion-extension under 0.05 Hz and +/- 6-nm sinusoidal waveform. The specimens underwent TLIF (with posterior pedicle fixation) and anterior ALIF (with intact posterior fixation). Multidirectional flexibility testing was conducted following each step. The ROM and NZ data were measured and calculated for each test. Globally, the TLIF and revision ALIF procedures significantly reduced ROM and NZ compared with that of the intact condition. The revision ALIF procedures achieved similar ROM as the TLIF procedure. Revision ALIF maintained biomechanical stability of TLIF in nonosteoporotic spines. Revision ALIF can be performed without sacrificing spinal stability in cases of intact posterior instrumentation.