Motion of threaded cages in posterior lumbar interbody fusion

A high rate of pseudarthrosis and a high overall rate of implant migration requiring surgical revision has been reported following posterior lumbar in terbody fusion using BAK threaded cages. The high rate of both pseudarthros is and implant migration may be due to poor fixation of the implant. The pu rpose of this study was to analyse the motion of threaded cages in posterio r lumbar interbody fusion. Six cadaveric human lumbar spine segments (three L2/3 and three L4/5 segments) were prepared for biomechanical testing. The segments were tested, without preload, under forces of axial compression ( 600 N), torsion (25 Nm) and shearing force (250 N). The tests were performe d first with the segments in an intact state, and subsequently following in strumented stabilisation with two BAK cages via a posterior approach. These results were compared with those of a finite element model simulating the effects of identical forces on the segments with constructs. As the results were comparable, the finite element model was used for analysing the motio n of BAK cages within the disc space. Motion of the implants was not seen i n compression. In torsion, a rolling motion was noted, with a range of moti on of 10.6 degrees around the central axis of the implant when left/right t orsion (25 Nm) was applied. The way the implants move within the segment ma y be due to their special shape: the thread of the implants can not prevent the BAK cages rolling within the disc space.