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Background  This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations.    Methods  Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS).    Results  Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP ( P  < 0.01), and bilateral greater than unilateral ( P  < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP ( P  < 0.01), however, UPS and LP showed similar reduction ( P  = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 ( P  = 0.57) and L3/4 ( P  = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP.    Conclusions  The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.

Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation