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Liu G, Huang W, Leng N, He P, Li X, Lin M, Lian Z, Wang Y, Chen J, Cai W. Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study. Bioengineering (Basel) 2024; 11:519. [PMID: 38790385 PMCID: PMC11117612 DOI: 10.3390/bioengineering11050519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
A novel H-shaped miniplate (HSM) was specifically designed for restorative laminoplasties to restore patients' posterior elements after laminectomies. A validated finite element (FE) model of L2/4 was utilized to create a laminectomy model, as well as three restorative laminoplasty models based on the fixation of different miniplates after a laminectomy (the RL-HSM model, the RL-LSM model, and the RL-THM model). The biomechanical effects of motion and displacement on a laminectomy and restorative laminoplasty with three different shapes for the fixation of miniplates were compared under the same mechanical conditions. This study aimed to validate the biomechanical stability, efficacy, and feasibility of a restorative laminoplasty with the fixation of miniplates post laminectomy. The laminectomy model demonstrated the greatest increase in motion and displacement, especially in axial rotation, followed by extension, flexion, and lateral bending. The restorative laminoplasty was exceptional in preserving the motion and displacement of surgical segments when compared to the intact state. This preservation was particularly evident in lateral bending and flexion/extension, with a slight maintenance efficacy observed in axial rotation. Compared to the laminectomy model, the restorative laminoplasties with the investigated miniplates demonstrated a motion-limiting effect for all directions and resulted in excellent stability levels under axial rotation and flexion/extension. The greatest reduction in motion and displacement was observed in the RL-HSM model, followed by the RL-LSM model and then the RL-THM model. When comparing the fixation of different miniplates in restorative laminoplasties, the HSMs were found to be superior to the LSMs and THMs in maintaining postoperative stability, particularly in axial rotation. The evidence suggests that a restorative laminoplasty with the fixation of miniplates is more effective than a conventional laminectomy due to the biomechanical effects of restoring posterior elements, which helps patients regain motion and limit load displacement responses in the spine after surgery, especially in axial rotation and flexion/extension. Additionally, our evaluation in this research study could benefit from further research and provide a methodological and modeling basis for the design and optimization of restorative laminoplasties.
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Affiliation(s)
- Guoyin Liu
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Weiqian Huang
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Nannan Leng
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Peng He
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Xin Li
- Department of Orthopedics, Central Military Commission Joint Logistics Support Force 904th Hospital, Wuxi 214044, China;
| | - Muliang Lin
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Zhonghua Lian
- Xiamen Medical Device Research and Testing Center, Xiamen 361022, China;
| | - Yong Wang
- Outpatient Department of The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China;
| | - Jianmin Chen
- Department of Orthopedics, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing 211166, China; (G.L.); (W.H.); (N.L.); (P.H.); (M.L.)
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Xu F, Lin J, Jiang S, Sun Z, Zhou S, Li Z, Wang S, Li W. In vivo segmental vertebral kinematics in patients with degenerative lumbar scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:571-581. [PMID: 37831181 DOI: 10.1007/s00586-023-07974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study aimed to find a standard of the vertebra kinematics during functional weight-bearing activities in degenerative lumbar scoliosis (DLS) patients. METHODS Fifty-four patients were involved into this study with forty-two in DLS group and twelve in the control group. The three-dimensional (3D) vertebral models from L1 to S1 of each participant were reconstructed by computed tomography (CT). Dual-orthogonal fluoroscopic imaging, along with FluoMotion and Rhinoceros software, was used to record segmental vertebral kinematics during functional weight-bearing activities. The primary and coupled motions of each vertebra were analyzed in patients with DLS. RESULTS During flexion-extension of the trunk, anteroposterior (AP) translation and craniocaudal (CC) translation at L5-S1 were higher than those at L2-3 (9.3 ± 5.1 mm vs. 6.4 ± 3.5 mm; P < 0.05). The coupled mediolateral (ML) translation at L5-S1 in patients with DLS was approximately three times greater than that in the control group. During left-right bending of the trunk, the coupled ML rotation at L5-S1 was higher in patients with DLS than that in the control group (17.7 ± 10.3° vs. 8.4 ± 4.4°; P < 0.05). The AP and CC translations at L5-S1 were higher than those at L1-2, L2-3, and L3-4. During left-right torsion of the trunk, the AP translation at L5-S1 was higher as compared to other levels. CONCLUSIONS The greatest coupled translation was observed at L5-S1 in patients with DLS. Coupled AP and ML translations at L5-S1 were higher than those in healthy participants. These data improved the understanding of DLS motion characteristics.
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Affiliation(s)
- Fei Xu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Jialiang Lin
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
- Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, 20043, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Ochtman AEA, Bisschop A, Bleys RLAW, Öner FC, van Gaalen SM. Surgical techniques in restoration lumbar lordosis: a biomechanical human cadaveric study. Spine Deform 2023; 11:35-40. [PMID: 35951242 PMCID: PMC9768003 DOI: 10.1007/s43390-022-00549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Degenerative changes of the lumbar spine lead in general to decrease of lumbar lordosis (LL). This change affects the overall balance of the spine, and when surgery is deemed, necessary restoration of the LL is considered. How this restoration can be achieved is a matter of controversy. The main purpose of this cadaveric study was to investigate the different steps of common posterior surgical techniques to understand the contribution of each successive step in restoring LL. METHODS Ten fresh-frozen human lumbar spine specimens were used to perform a sequential correction and instrumentation with a pedicle screw construct. RESULTS The mean LL angle measured at L3-L4 in intact condition was 12.9°; after screw insertion and compression, this increased to 13.8° (+ 7%, p = 0.04), after bilateral facetectomy to 16.3° (+ 20%, p = 0.005), after discectomy and insertion of interbody cage to 18.0º (+ 9%, p = 0.012), after resection of the lamina and the processes spinosus to 19.8° (+ 10%, p = 0.017), and after resection of the anterior longitudinal ligament to 25.4° (+ 22%, p = 0.005). CONCLUSIONS Each step contributed statistically significant to restoration of segmental lordosis with bilateral facetectomy contributing the most in terms of percentage. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A. E. A. Ochtman
- grid.7692.a0000000090126352Department of Orthopedics, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, The Netherlands
| | - A. Bisschop
- grid.16872.3a0000 0004 0435 165XDepartment of Orthopedics, VU University Medical Center, Amsterdam, The Netherlands
| | - R. L. A. W. Bleys
- grid.7692.a0000000090126352Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F. C. Öner
- grid.7692.a0000000090126352Department of Orthopedics, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, The Netherlands
| | - S. M. van Gaalen
- Acibadem International Medical Center, Arlandaweg 100, 1043 HP Amsterdam, The Netherlands
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Nolte MT, Louie PK, Basques BA, Varthi AG, Paul JC, Khanna K, Khurana T, Chaudhri A, Samartzis D, Goldberg EJ, An HS. Patients Undergoing 3-Level-or-Greater Decompression-Only Surgery for Lumbar Spinal Stenosis Have Similar Outcomes to Those Undergoing Single-Level Surgery at 2 Years. Int J Spine Surg 2021; 15:945-952. [PMID: 34551931 PMCID: PMC8651207 DOI: 10.14444/8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stability following multilevel decompressive laminectomy without fusion has been debated using in vitro biomechanical and radiographic models. However, there is a lack of information regarding clinical outcomes for these patients. The aim of the present study was to determine the association between clinical outcomes and number of levels decompressed via laminectomy for treatment of lumbar spinal stenosis. METHODS We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were divided into 2 groups based on the number of decompression levels: single level or 3 or more levels. Patient-reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey scores, and Veterans Rand 12-Item Health Mental and Physical Survey scores. RESULTS Overall, 138 consecutive patients were assessed, of which 106 underwent a single-level and 32 underwent a 3-or-more-level laminectomy. Average follow-up was 24.2 months. There were no significant differences in the preoperative VAS back, VAS leg, or ODI scores between the single-level laminectomy and 3-or-more-level laminectomy groups. Both groups of patients experienced significant improvements in these clinical outcomes postoperatively with no clinically significant difference in the degree of improvement. Reoperation rates were low and similar between the 2 groups. CONCLUSIONS Patients undergoing decompression of 3 or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Under specific clinical and radiographic criteria, a multilevel decompression of 3 or more levels may be a safe and effective procedure with acceptable outcomes at 2 years after surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael T. Nolte
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Philip K. Louie
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York
| | - Bryce A. Basques
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Arya G. Varthi
- Yale School of Medicine, Orthopaedics, and Rehabilitation, New Haven, Connecticut
| | | | - Krishn Khanna
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Tarush Khurana
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Arshan Chaudhri
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Dino Samartzis
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Edward J. Goldberg
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
| | - Howard S. An
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois
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Liu L, Ma HY, Yuan QL, Zhao XM, Lou XX, Zhang YG. Biomechanical effects of reconstruction of the posterior structures after laminectomy with an individualized poly-ether-ether-ketone (PEEK) artificial lamina. J Biomater Appl 2020; 35:1327-1336. [PMID: 33349103 DOI: 10.1177/0885328220981191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laminectomy is a traditional method for treating lumbar diseases; however, the destruction of the posterior structures may cause postoperative symptoms. An individualized poly-ether-ether-ketone (PEEK) artificial lamina was designed to reconstruct the posterior structures after laminectomy. This study aimed to explore the biomechanical effects of reconstruction of the posterior structures with an individualized PEEK artificial lamina using validated finite element models. OBJECTIVE To examine the biomechanical effects of individualized PEEK artificial lamina on postlaminectomy lumbar. METHODS A finite element (FE) model of L3-5 was developed based on computed tomography images. Four surgical models (laminectomy, artificial lamina alone, ligament reconstruction, and osseointegration) were constructed, representing different stages of L4 artificial lamina implantation. The range of motion (ROM), intradiscal pressure (IDP), stresses in the annulus fibrosus at the surgical level and cephalad adjacent level, and stresses in the artificial lamina and screws were measured. RESULTS The ROM, IDP, and stresses in the annulus fibrosus of the different artificial lamina models decreased compared to those of the laminectomy model at both surgical and adjacent levels for all motion patterns, most notably in the osseointegration model. In addition, the results of the stresses in the implants showed that the artificial lamina could enhance the lumbar isthmus and disperse the abnormally concentrated stresses after laminectomy. CONCLUSION The application of a PEEK artificial lamina has the potential to stabilize the postlaminectomy lumbar spine and prevent adjacent segment disease (ASD) and iatrogenic lumbar deformities, resulting in a reduction in the incidence of post-lumbar surgery syndrome.
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Affiliation(s)
- Liang Liu
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Talent Highland, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hong-Yun Ma
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Qi-Ling Yuan
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiao-Ming Zhao
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiao-Xiao Lou
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yin-Gang Zhang
- Department of Orthopaedics, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
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Biomechanical properties in motion of lumbar spines with degenerative scoliosis. J Biomech 2019; 102:109495. [PMID: 31767285 DOI: 10.1016/j.jbiomech.2019.109495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/26/2019] [Accepted: 11/05/2019] [Indexed: 11/21/2022]
Abstract
Degenerative lumbar scoliosis presumably alters spinal biomechanics, but a lack of quantitative reference measurements of these spines exists. We aimed to assess the biomechanical properties of spines with degenerative scoliosis, and to relate these to intervertebral disc degeneration (DD) and Cobb angle. Secondly, we compared these results to previous measurements of non-scoliotic spines. Ten cadaveric spines (Th12-L5, mean age 82 ± 11 years) with Cobb angle ≥10° and apex at L3 were acquired. Three loading cycles (-4 to 4 Nm) were applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR). The range of motion (ROM), neutral zone (NZ) stiffness, NZ ROM, elastic zone (EZ) stiffness and hysteresis were calculated for each motion segment in the loading direction. ROM was calculated in coupled directions, expressed as a percentage of rotation in the loaded direction. For Th12-L5, there was a ROM (degrees ± SD) of 14.9 ± 6.5 in FE, 14.9 ± 7.8 in LB, and 10.2 ± 5.5 in AR. The median (Nm/degree (Q1;Q3)) NZs was 0.24 (0.19;0.35) in FE, 0.25 (0.22;0.42) in LB, and 0.49 (0.33;0.99) in AR. Greater coupled motions related to higher Cobb angle, especially during AR on segments around the apex (FE: ρ = 0.539, p = 0.021 and LB: ρ = 0.821, p = 0.000). DD correlated to lower ROM and increased NZs on L2-L3 in FE (ρ = -0.721, p = 0.028 and ρ = 0.694, p = 0.038, respectively). Compared to non-scoliotic spines, smaller ROM in FE (p = 0.030) was found. This study describes the biomechanical properties of lumbar spines with degenerative scoliosis. Compared to non-scoliotic spines, they tended to be stiffer and exhibited smaller ROM in FE. DD only affected the ROM and NZs of the segments around the apex.
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Kim JH, Ryu DS, Yoon SH. Is Adjacent Segment Disease More Frequent in Proximal Levels in Comparison with Distal Levels? Based on Radiological Data of at Least 2 Years Follow Up with More than 2 Level Thoracolumbar Fusions. J Korean Neurosurg Soc 2019; 62:603-609. [PMID: 31484235 PMCID: PMC6732351 DOI: 10.3340/jkns.2019.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions.
Methods The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On preop magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb’s angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed.
Results Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846).
Conclusion In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.
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Affiliation(s)
- Jung-Ho Kim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Dal-Sung Ryu
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Seung-Hwan Yoon
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
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Rustenburg CME, Faraj SSA, Holewijn RM, Kingma I, van Royen BJ, Stadhouder A, Emanuel KS. The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study. Neurosurg Focus 2019; 46:E15. [PMID: 31042658 DOI: 10.3171/2019.2.focus1911] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDegenerative lumbar scoliosis, or de novo degenerative lumbar scoliosis, can result in spinal canal stenosis, which is often accompanied by disabling symptoms. When surgically treated, a single-level laminectomy is performed and short-segment posterior instrumentation is placed to restore stability. However, the effects of laminectomy on spinal stability and the necessity of placing posterior instrumentation are unknown. Therefore, the aim of this study was to assess the stability of lumbar spines with degenerative scoliosis, characterized by the range of motion (ROM) and neutral zone (NZ) stiffness, after laminectomy and placement of posterior instrumentation.METHODSTen lumbar cadaveric spines (T12-L5) with a Cobb angle ≥ 10° and an apex on L3 were included. Three loading cycles were applied per direction, from -4 Nm to 4 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR). Biomechanical evaluation was performed on the native spines and after subsequent L3 laminectomy and the placement of posterior L2-4 titanium rods and pedicle screws. Nonparametric and parametric tests were used to analyze the effects of laminectomy and posterior instrumentation on NZ stiffness and ROM, respectively, both on an individual segment's motion and on the entire spine section. Spearman's rank correlation coefficient was used to study the correlation between disc degeneration and spinal stability.RESULTSThe laminectomy increased ROM by 9.5% in FE (p = 0.04) and 4.6% in LB (p = 0.01). For NZ stiffness, the laminectomy produced no significant effects. Posterior instrumentation resulted in a decrease in ROM in all loading directions (-22.2%, -24.4%, and -17.6% for FE, LB, and AR, respectively; all p < 0.05) and an increase in NZ stiffness (+44.7%, +51.7%, and +35.2% for FE, LB, and AR, respectively; all p < 0.05). The same changes were seen in the individual segments around the apex, while the adjacent, untreated segments were mostly unaffected. Intervertebral disc degeneration was found to be positively correlated to decreased ROM and increased NZ stiffness.CONCLUSIONSLaminectomy in lumbar spines with degenerative scoliosis did not result in severe spinal instability, whereas posterior instrumentation resulted in a rigid construct. Also, prior to surgery, the spines already had lower ROM and higher NZ stiffness in comparison to values shown in earlier studies on nonscoliotic spines of the same age. Hence, the authors question the clinical need for posterior instrumentation to avoid instability.
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Affiliation(s)
| | - Sayf S A Faraj
- 2Department of Orthopedic Surgery, Radboud UMC, Nijmegen
| | | | - Idsart Kingma
- 4Amsterdam Movement Sciences, Faculty of Movement Sciences, Vrije Universiteit, Amsterdam; and
| | - Barend J van Royen
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam
| | - Agnita Stadhouder
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam
| | - Kaj S Emanuel
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam.,5Department of Orthopaedic Surgery, Maastricht UMC+, Maastricht, The Netherlands
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Amaral R, Ferreira R, Marchi L, Jensen R, Nogueira-Neto J, Pimenta L. Stand-alone anterior lumbar interbody fusion - complications and perioperative results. Rev Bras Ortop 2017; 52:569-574. [PMID: 29062822 PMCID: PMC5643906 DOI: 10.1016/j.rboe.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Historically, anterior lumbar interbody fusion (ALIF) was related to high rates of intraoperative complications and adverse events related to interbody devices. In recent decades, there have been technical adjustments, and cages that are more suitable have emerged. The aim of this study is to evaluate the efficacy and complication rate of the use of stand-alone mini-ALIF using a self-locking cage. METHODS Retrospective single center study. Inclusion criteria: retroperitoneal mini-ALIF for single-level fusion (L5S1); self-locking cage; DDD/stenosis and grade I spondylolisthesis. Exclusion criteria: posterior supplementation, previous fusion/arthroplasty. Endpoints: surgery data, intraoperative and perioperative adverse events related both to surgical access and to the intersomatic device. RESULTS Eighty-seven cases were enrolled. Median surgical time was 90 min; median blood loss was 100 mL. The median length of stay in the ICU was zero days; median hospital stay was one day. Ten cases had an adverse event (11.5%): four major adverse events (4.6%; 3 L bleeding; DVT; retroperitoneal haematoma; incisional hernia), and seven minor events (8%; peritoneum injury; minor vascular injury; events related to the cage). No cases of retrograde ejaculation were observed. There was improvement in pain, physical restriction, and quality of life (p < 0.001). CONCLUSIONS The mini-ALIF procedure performed for single-level fusion at the distal lumbar level demonstrated low adverse event rates related to both the surgical approach and to the intersomatic device, with reduced hospital stay and satisfactory perioperative clinical results.
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Affiliation(s)
- Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | - Luis Marchi
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | - Rubens Jensen
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.,University of California San Diego (UCSD), San Diego, United States
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Amaral R, Ferreira R, Marchi L, Jensen R, Nogueira‐Neto J, Pimenta L. Artrodese lombar intersomática anterior por via única – Complicações e resultados perioperatórios. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Holewijn RM, de Kleuver M, van der Veen AJ, Emanuel KS, Bisschop A, Stadhouder A, van Royen BJ, Kingma I. A Novel Spinal Implant for Fusionless Scoliosis Correction: A Biomechanical Analysis of the Motion Preserving Properties of a Posterior Periapical Concave Distraction Device. Global Spine J 2017; 7:400-409. [PMID: 28811983 PMCID: PMC5544155 DOI: 10.1177/2192568217699377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Biomechanical study. OBJECTIVE Recently, a posterior concave periapical distraction device for fusionless scoliosis correction was introduced. The goal of this study was to quantify the effect of the periapical distraction device on spinal range of motion (ROM) in comparison with traditional rigid pedicle screw-rod instrumentation. METHODS Using a spinal motion simulator, 6 human spines were loaded with 4 N m and 6 porcine spines with 2 N m to induce flexion-extension (FE), lateral bending (LB), and axial rotation (AR). ROM was measured in 3 conditions: untreated, periapical distraction device, and rigid pedicle screw-rod instrumentation. RESULTS The periapical distraction device caused a significant (P < .05) decrease in ROM of FE (human, -40.0% and porcine, -55.9%) and LB (human, -18.2% and porcine, -17.9%) as compared to the untreated spine, while ROM of AR remained unaffected. In comparison, rigid instrumentation caused a significantly (P < .05) larger decrease in ROM of FE (human, -80.9% and porcine, -94.0%), LB (human, -75.0% and porcine, -92.2%), and AR (human, -71.3% and porcine, -86.9%). CONCLUSIONS Although no destructive forces were applied, no device failures were observed. Spinal ROM was significantly less constrained by the periapical distraction device compared to rigid pedicle screw-rod instrumentation. Therefore, provided that scoliosis correction is achieved, a more physiological spinal motion is expected after scoliosis correction with the posterior concave periapical distraction device.
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Affiliation(s)
- Roderick M. Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Albert J. van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arno Bisschop
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Barend J. van Royen
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands,Idsart Kingma, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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Abstract
Adjacent segment disease (ASD) is disappointing long-term outcome for both the patient and clinician. In contrast to adjacent segment degeneration, which is a common radiographic finding, ASD is less common. The incidence of ASD in both the cervical and lumbar spine is between 2% and 4% per year, and ASD is a significant contributor to reoperation rates after spinal arthrodesis. The etiology of ASD is multifactorial, stemming from existing spondylosis at adjacent levels, predisposed risk to degenerative changes, and altered biomechanical forces near a previous fusion site. Numerous studies have sought to identify both patient and surgical risk factors for ASD, but a consistent, sole predictor has yet to be found. Spinal arthroplasty techniques seek to preserve physiological biomechanics, thereby minimizing the risk of ASD, and long-term clinical outcome studies will help quantify its efficacy. Treatment strategies for ASD are initially nonoperative, provided a progressive neurological deficit is not present. The spine surgeon is afforded many surgical strategies once operative treatment is elected. The goal of this manuscript is to consider the etiologies of ASD, review its manifestations, and offer an approach to treatment.
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Holewijn RM, Faraj SSA, Kingma I, van Royen BJ, de Kleuver M, van der Veen AJ. Spinal biomechanical properties are significantly altered with a novel embalming method. J Biomech 2017; 55:144-146. [PMID: 28259461 DOI: 10.1016/j.jbiomech.2017.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/01/2017] [Accepted: 02/11/2017] [Indexed: 11/25/2022]
Abstract
In vitro tests on the biomechanical properties of human spines are often performed using fresh frozen specimens. However, this carries the risk of pathogen transfer from specimen to the worker and the specimens can only be used for a limited amount of time. Human spinal specimens embalmed with formaldehyde carry an almost absent risk of transfer of pathogens and can be stored and used for a long time, but the tissue properties are strongly affected making this method inapplicable for biomechanical testing. In this study, a new embalming technique called Fix for Life (F4L), which claims to preserve the tissue properties, was tested. The range of motion (ROM) and stiffness of six fresh human spinal specimens was measured using a spinal motion simulator before and after F4L embalming. After F4L embalming, spinal stiffness increased in flexion-extension by 230%, in lateral bending by 284% and in axial rotation by 271%. ROM decreased by 46% in flexion-extension, 56% in lateral bending and 54% in axial rotation. In conclusion, based on this study, F4L does not maintain physiological spinal biomechanical properties, and we propose that this method should not be used for biomechanical studies. Nevertheless, the method may be an alternative to formaldehyde fixation in situations such as training and education because the effect on spinal biomechanics is less detrimental than formaldehyde and tissue color is maintained.
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Affiliation(s)
- Roderick M Holewijn
- Department of Orthopedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Sayf S A Faraj
- Department of Orthopedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Idsart Kingma
- Faculty of Human Movement Sciences, Research Institute MOVE, VU University, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - Barend J van Royen
- Department of Orthopedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopedic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Epstein NE. Adjacent level disease following lumbar spine surgery: A review. Surg Neurol Int 2015; 6:S591-9. [PMID: 26693387 PMCID: PMC4671141 DOI: 10.4103/2152-7806.170432] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Instrumented lumbar spine surgery is associated with an increased risk of adjacent segment disease (ASD). Multiple studies have explored the various risk factors contributing to ASD that include; fusion length (especially, three or more levels), sagittal malalignment, facet injury, advanced age, and prior cephalad degenerative disease. Methods: In this selective review of ASD, following predominantly instrumented fusions for lumbar degenerative disease, patients typically underwent open versus minimally invasive surgery (MIS), transforaminal lumbar interbody fusions (TLIFs), posterior lumbar interbody fusions (PLIFs), or rarely posterolateral lumbar instrumented or noninstrumented fusions (posterolateral lumbar fusion). Results: The incidence of ASD, following open or MI lumbar instrumented fusions, ranged up to 30%; notably, the addition of instrumentation in different series did not correlate with improved outcomes. Alternatively, in one series, at 164 postoperative months, noninstrumented lumbar fusions reduced the incidence of ASD to 5.6% versus 18.5% for ASD performed with instrumentation. Of interest, dynamic instrumented/stabilization techniques did not protect patients from ASD. Furthermore, in a series of 513 MIS TLIF, there was a 15.6% incidence of perioperative complications that included; a 5.1% frequency of durotomy and a 2.3% instrumentation failure rate. Conclusions: The incidence of postoperative ASD (up to 30%) is greater following either open or MIS instrumented lumbar fusions (e.g., TLIF/PLIF), while decompressions with noninstrumented fusions led to a much smaller 5.6% risk of ASD. Other findings included: MIS instrumented fusions contributed to higher perioperative complication rates, and dynamic stabilization did not protect against ASD.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, NY 11501, USA
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