Biomechanical Analysis of an Expandable Lumbar Interbody Spacer

Hector Soriano-Baron, Anna G.U.S. Newcomb, Devika Malhotra, Atilio E. Palma, Eduardo Martinez-del-Campo, Neil R. Crawford, Nicholas Theodore, Brian P. Kelly, Taro Kaibara

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: Recently developed expandable interbody spacers are widely accepted in spinal surgery; however, the resulting biomechanical effects of their use have not yet been fully studied. We analyzed the biomechanical effects of an expandable polyetheretherketone interbody spacer inserted through a bilateral posterior approach with and without different modalities of posterior augmentation. Methods: Biomechanical nondestructive flexibility testing was performed in 7 human cadaveric lumbar (L2–L5) specimens followed by axial compressive loading. Each specimen was tested under 6 conditions: 1) intact, 2) bilateral L3–L4 cortical screw/rod (CSR) alone, 3) WaveD alone, 4) WaveD + CSR, 5) WaveD + bilateral L3–L4 pedicle screw/rod (PSR), and 6) WaveD + CSR/PSR, where CSR/PSR was a hybrid construct comprising bilateral cortical-level L3 and pedicle-level L4 screws interconnected by rods. Results: The range of motion (ROM) with the interbody spacer alone decreased significantly compared with the intact condition during flexion–extension (P = 0.02) but not during lateral bending or axial rotation (P ≥ 0.19). The addition of CSR or PSR to the interbody spacer alone condition significantly decreased the ROM compared with the interbody spacer alone (P ≤ 0.002); and WaveD + CSR, WaveD + PSR, and WaveD + CSR/PSR (hybrid) (P ≥ 0.29) did not differ. The axial compressive stiffness (resistance to change in foraminal height during compressive loading) with the interbody spacer alone did not differ from the intact condition (P = 0.96), whereas WaveD + posterior instrumentation significantly increased compressive stiffness compared with the intact condition and the interbody spacer alone (P ≤ 0.001). Conclusions: The WaveD alone significantly reduced ROM during flexion–extension while maintaining the axial compressive stiffness. CSR, PSR, and CSR/PSR hybrid constructs were all effective in augmenting the expandable interbody spacer system and improving its stability.

Original languageEnglish (US)
Pages (from-to)e616-e623
JournalWorld neurosurgery
StatePublished - Jun 2018
Externally publishedYes


  • Axial compression
  • Cortical screw
  • In vitro testing
  • Interbody spacer
  • Posterior fusion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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