ArticleCureus2023
Endplate Trauma During Implant Insertion Affects the Expulsion Risk of Anterior Lumbar Interbody Fusion Devices.
Article in Cureus, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 4 citations in OpenAlex.
- Radiographic Evaluation of a Modular Anterior Lumbar Interbody Fusion (ALIF) Cage: Subsidence and Segmental Lordosis.Cureus · 2026Article
- Section on innovative spine research and novel technologies: fusion cage design, materials, and coatings: Science versus hype.North American Spine Society journal · 2025Article
- Comparison of patient outcomes of anterior and posterior lumbar interbody fusions: A retrospective national database analysis.Journal of orthopaedics · 2025Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Anterior cage migration in anterior lumbar interbody fusion is a serious complication. To address this risk, cage designs are now available with integrated screw or blade fixation or specially designed surface geometries with large teeth or ridges. However, the implantation technique itself has not yet been addressed as a potential risk factor for cage migration. This study aimed to investigate whether a cage that is implantable without gouging the vertebral endplates has improved resistance to anterior migration. Methodology A novel three-piece modular cage was inserted between two vertebral body replacements (polyurethane (PU) foam grade 15 pcf) in two ways. In group 1 (modular), the cage was inserted in a wedge within a wedge fashion according to the manufacturer's instructions such that damage to the PU foam was minimized. In group 2 (mono-bloc), the modular cage was inserted pre-assembled as a one-piece, mono-bloc device. This insertion method required impaction and increased the potential of gouging the PU surfaces. Then, an axial preload was applied to the PU test blocks to simulate the preload on the spine in vivo and an anteriorly direct expulsion force was applied to the cages. Results The mean expulsion yield load in the test group with modular implantation was 392 ± 19 N compared to 287 ± 16 N in the test group where the mono-bloc implants were inserted and endplate gouging occurred. This difference was statistically significant (p < 0.05). Thus, the onset of cage migration occurred at significantly higher loads in the test group with modular insertion without endplate gouging compared to one-piece impaction with gouging taking place. In contrast, the stiffness and the ultimate load were similar in both test groups (p > 0.05). Conclusions This study showed that the cage insertion technique may have a significant effect on the cage migration risk. Prevention of endplate gouging during cage implantation has the potential to improve the primary stability of the cage.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.