Clinical Evidence
Explore the clinical literature that discusses the importance of high quality, complete disc preparation.
Revision strategies for lumbar pseudarthrosis
“An often under-appreciated aspect of pseudarthrosis prevention or treatment is preparation of the host fusion site for graft placement. This preparation is essential to establishing an ideal environment to allow bone fusion to occur. Meticulous attention is given to soft-tissue removal from bone surfaces awaiting grafting. This can decrease fibrous ingrowth into the fusion bed.”
“In anterior-column graft site preparations, the osseous endplate must have all soft tissue removed. Small amounts of bone-related bleeding should occur without complete disruption of the structural integrity of the endplate. In this way, ideal site preparation can be accomplished while maintaining structural integrity to minimize later subsidence.”
Ondra, S. L., & Marzouk, S. (2003). Revision strategies for lumbar pseudarthrosis. Neurosurgical Focus, 15(3), 1–5. https://doi.org/10.3171/foc.2003.15.3.9
Progress, Challenges And Opportunities In Disc Space Preparation For Lumbar Interbody Fusion
“For a solid fusion to occur it is essential that a thorough discectomy be performed, as well as, thorough removal of vertebral endplate cartilage. Failure to do so could result in nonunion and development of a pseudoarthrosis. While conventional TLIF has been shown to reduce complications, there is evidence that posterior unilateral techniques do not permit as thorough a discectomy and endplate preparation.”
“While most agree that it is necessary to graft at least 50% of the total disc area, computation on CT scans reveal that less than 50% of the disc area is actually grafted in many cases.”
“Tools designed for the transforaminal approach that allow preparation of a greater proportion of the disc space, and powered tools that reduce the time and manual insertions and withdrawals required to prepare the site, could provide tangible benefit.”
Sukovich, W., Progress, Challenges And Opportunities In Disc Space Preparation For Lumbar Interbody Fusion. The Internet Journal of Spine Surgery, 2004. 1(2).
Impact of sufficient contact between the autograft and endplate soon after surgery to prevent nonunion at 12 months following posterior lumbar interbody fusion
“Our results demonstrated that a lower occupancy rate of the autograft and the presence of a translucent zone between the autograft and endplate soon after the surgery were associated with intervertebral nonunion at 12 months after PLIF.”
“We believe that the presence of a translucent zone between the autograft and endplate soon after the surgery might be related to remnants of the cartilage endplates and/or inadequate bone grafting; therefore, it is essential to achieve sufficient contact between the autograft and endplate intraoperatively for osseous union enhancement after PLIF.”
Ushirozako, H., Hasegawa, T., Ebata, S., Ohba, T., Oba, H., Mukaiyama, K., Shimizu, S., Yamato, Y., Ide, K., Shibata, Y., Ojima, T., Takahashi, J., Haro, H., & Matsuyama, Y. (2020). Impact of sufficient contact between the autograft and endplate soon after surgery to prevent nonunion at 12 months following posterior lumbar interbody fusion. Journal of Neurosurgery: Spine, 33(6), 796–805. https://doi.org/10.3171/2020.5.spine20360
