Comparison of stabilities between obliquely and conventionally inserted Bagby and Kuslich cages as posterior lumbar interbody fusion in a cadaver model.

BACKGROUND

The Bagby and Kuslich (BAK) cage as posterior lumbar interbody fusion (PLIF) is reported to give satisfactory results in restoring spinal stability. Moreover, correction by obliquely inserting a single BAK cage has the advantages of reducing exposure, precise implantation, and lower cost. However, biomechanical data on this procedure are not abundant. This study was designed to compare the stability imparted by the cages placed using an oblique and posterior approaches and to determine the effects of supplementary posterior instrumentation.

METHODS

After affixing nine human cadaveric spines (L2-S1) within a testing frame, load testing in several clinically relevant modes was performed sequentially for the intact and the following procedures across the L4-5 segments: posterior destabilization, stabilization using 2 parallel BAK cages (CBAK group) or 1 oblique BAK cage (OBAK group), and additional stabilization with posterior instrumentation. Spatial locations of vertebral bodies were recorded after each loading step using a 3-D motion measurement system.

RESULTS

Except the OBAK group that had a lower stability in left axial rotation, there were no significant differences in the stability between both groups in all loading modes for the stabilization using cages alone. Compared with the intact cases, CBAK cages provide significant improvement in the stability in 5 displacement modes and OBAK cage may restore the stabilities of the specimens to the intact state in 5 modes and provide significant improvement in flexion. Addition of supplementary posterior instrumentation significantly reduced the angular displacements in both groups.

CONCLUSIONS

Both methods of cage insertion have similar stability. Both implantations, alone or with posterior instrumentation, may improve the stability of the spine, although posterior instrumentation may further strengthen the stability. The oblique insertion is more favorable since it requires less exposure, enables precise implantation, and is less expensive.