“The Effect of a lordotic expandable interbody implant in ...E-POSTER #51 • Minimally Invasive Surgery has seen a tremendous change with greater emphasis placed on interbody technologies

“THE EFFECT OF A LORDOTIC EXPANDABLE INTERBODY IMPLANT IN COMPARISON TO A

LORDOTIC FIXED INTERBODY IMPLANT IN MINIMALLY INVASIVE SPINE SURGERY: ITS EFFECT ON SAGITTAL ALIGNMENT AND RESTORATION OF

DISC HEIGHT AND FORAMINAL HEIGHT”

E-POSTER #51

Donald W Kucharzyk, DODushan Budimir, MS

DK Orthopedics

Center for Spine Minimally Invasive SurgeryCrown Point, Indiana

“THE EFFECT OF A LORDOTIC EXPANDABLE INTERBODY IMPLANT IN COMPARISON TO A LORDOTIC FIXED INTERBODY IMPLANT IN

MINIMALLY INVASIVE SPINE SURGERY: ITS EFFECT ON SAGITTAL ALIGNMENT AND RESTORATION OF DISC HEIGHT AND FORAMINAL

HEIGHT”E-POSTER #51

• Minimally Invasive Surgery has seen a tremendous change with greater emphasis placed on interbody technologies in the re-establishment of sagittal alignment, disc height restoration and fusion in the absence of a posterolateral arthrodesis

• The goal being to minimize muscle damage and spare the paraspinal muscles that can lead to poor outcomes, persistant pain and weakness as well as correcting all the pathologies

• As technologies have evolved in MIS surgeries so has the focus on the type and designs of the interbody implants

• Transitioning from those of the classic PLIF type design to an Oblique design which is more adaptable to MIS insertion

• While paying more attention to the degree of lordosis of the implant to aide in the re-establishment of sagittal alignment and segmental lordosis




• But with this evolving technologies comes concerns as to the ability to insert these implants without endplate violation and the ability of the fixed implants to achieve their goal

• That goal being the improvement in sagittal balance and restoration of disc height and segmental lordosis

• But the fixed implants do have limitations especially in tight disc spaces and collapsed disc spaces that are difficult to distract thru an oblique approach

• Newer Interbodies designs that feature in-situ expansion with a larger surface area with lordosis have recently become available and offer advantages over the fixed interbody implants

• These advantages center around uniform distraction over a larger surface area thus potentially eliminating endplate violation that can lead to subsidence




• A Retrospective Study was undertaken to compare the effects of an expandable PEEK interbody implant versus an Oblique PEEK implant inserted via an MIS approach

• 100 patients were evaluated with 50 in each group:• 8-degree fixed lordotic Oblique implant and 8-degree

lordotic LUNA 360 implant• The fixed lordotic implant is a PEEK Oblique Interbody

implant with 8 degrees of lordosis with variable heights and lengths for proper placement and patient specificity

• The expandable implant is the LUNA 360 PEEK interbody implant that allows for an MIS approach thru a 8mm working canal with in situ deployment and expansion that achieves an ALIF footprint with 8 degree’s of lordosis




• All patients were evaluated for anterior and posterior disc heights, average disc height, segmental lordosis, foraminal height, subsidence and fusion

• All were followed for two years with follow-up at 1,3,6,12,18, and 24 months with CT Scans performed at 12 months

RESULTS




ANTERIOR DISC HEIGHTLUNA 360 EXPANDABLE OBLIQUE IMPLANT

Preop Postop Preop Postop7.6mm 15.7mm 10.3mm 12.1mm

Change Change8.1mm (106.6%) 1.8mm (17.5%)




POSTERIOR DISC HEIGHTLUNA 360 EXPANDABLE OBLIQUE IMPLANT


Change Change7.4mm (370%) 2.5mm (54.3%)




AVERAGE DISC HEIGHTLUNA 360 EXPANDABLE OBLIQUE IMPLANT


Change Change8.8mm (183.3%) 2.5mm (18.7%)




SEGMENTAL LORDOTIC ANGLELUNA 360 EXPANDABLE OBLIQUE IMPLANT

Preop Postop Preop Postop5.6 degree’s 15 degree’s 8.4 degree’s 10.4 degree’s

Change Change9.4 degree’s (167.9%) 2.0 degree’s (23.8%)




FORAMINAL HEIGHTSLUNA 360 EXPANDABLE OBLIQUE IMPLANT


Change Change9.7mm (89.9%) 1.8 mm (12.1%)

SUBSIDENCELUNA 360 EXPANDABLE OBLIQUE IMPLANT1 superior endplate 9 contralateral side

FUSION93% 73%




• The expandable LUNA 360 PEEK lordotic implant outperformed the Oblique PEEK lordotic implant in all parameters significantly in posterior disc height and foraminal height restoration as well as segmental lordosis

• This is due to the larger footprint and uniform distraction across the endplate

• The design allows the ipsilateral and contralateral foramen to maintain their heights

• It also limits endplate violation as it uniformly distracts the disc space as opposed to the oblique that can violate the endplate as it is rotated into its position




• End plate violations were higher with the Oblique implants and this leads to subsidence as seen in the study which can effect fusion rates and outcomes

• The larger footprint also affords a larger graft window for graft placement and resulted in a higher fusion rate 93% compared to 73%

• The Luna 360 implant allows one to achieve improved outcomes thru a MIS approach to the spine

• Most Importantly: It provides the ability to avoid the gravest complication via this approach with this implant:

End-plate Violation

Documents

“The Effect of a lordotic expandable interbody implant in ...E-POSTER #51 • Minimally Invasive Surgery has seen a tremendous change with greater emphasis placed on interbody technologies