Relaxation Response of Lumbar Segments Undergoing Disc-Space Distraction Implications to the Stability of Anterior Lumbar Interbody Implants

Study Design. A biomechanical study of human cadaveric lumbar spine segments undergoing disc-space distraction for insertion of anterior lumbar interbody implants. Objective. To measure the distraction force and its relaxation during a period of up to 3 hours after disc-space distraction as a function of the distraction magnitude and disc level. Summary of Background Data. Interbody implants depend on compressive preload produced by disc-space distraction (annular pretension) for initial stabilization of the implant-bone interface. However, the amount of preload produced by disc-space distraction due to insertion of the implant and its subsequent relaxation have not been quantified. Methods. Twenty-two fresh human lumbar motion segments (age: 51 +/- 14.8 years) were used. An anterior lumbar discectomy was performed. The distraction test battery consisted of a tension stiffness test performed before and after each relaxation test, 2 distraction magnitudes of 2 and 4 mm, and a recovery period before each distraction input. The distraction forces and lordosis angles were measured. Results. Peak distraction force was significantly larger for the 4-mm distraction (431.8 +/- 116.4 N) than for the 2-mm distraction (204.9 +/- 55.5 N) (P < 0.01). The distraction force significantly decreased over time (P < 0.01), approximating steady-state values of 146.1 +/- 47.3 N at 2-mm distraction and 289.8 +/- 92.8 N at 4-mm distraction, respectively. The distraction force reduced in magnitude by more than 20% of peak value in the first 15 minutes and reduced by approximately 30% of the peak value at the end of the testing period. The spine segment relaxed by the same amount of force, regardless of the disc level (P > 0.05). Conclusion. The "tightness of fit" that the surgeon notes immediately after interbody device insertion in the disc space degrades in the very early postoperative period, which could compromise the stability of the bone-implant interface.