“The Effect of a lordotic expandable interbody implant in ...E-POSTER #51 • Minimally Invasive...

“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

“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

• 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

“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

• 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

“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

• 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

“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

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%)

“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

POSTERIOR DISC HEIGHTLUNA 360 EXPANDABLE OBLIQUE IMPLANT

Preop Postop Preop Postop2.0mm 9.4mm 4.6mm 7.1mm

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

“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

AVERAGE DISC HEIGHTLUNA 360 EXPANDABLE OBLIQUE IMPLANT

Preop Postop Preop Postop4.8mm 13.6mm 7.5mm 8.9mm

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

“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

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%)

“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

FORAMINAL HEIGHTSLUNA 360 EXPANDABLE OBLIQUE IMPLANT

Preop Postop Preop Postop10.5mm 20.2mm 14.9mm 16.7mm

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

SUBSIDENCELUNA 360 EXPANDABLE OBLIQUE IMPLANT1 superior endplate 9 contralateral side

FUSION93% 73%

“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

• 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

“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

• 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