Biomechanical Effect of Hybrid Dynamic Stabilization Implant on the Segmental Motion and Intradiscal Pressure in Human Lumbar Spine

Hsiao, Chih-Kun; Tsai, Yi-Jung; Yen, Cheng-Yo; Li, Yi‐Chen; Hsiao, Hao-Yuan; Tu, Yuan‐Kun

doi:10.3390/bioengineering10010031

Cited by 6 publications

(5 citation statements)

References 63 publications

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“…The IDP of each lumbar segment in the intact FE model was also consistent with the data from the study by Hsiao et al ( Supplementary Figure S1 ). ( Hsiao et al, 2022 ). The ROM of L2-S1 and LSJ in the No-SPF and SS-SR instrumented models was consistent with the data from the studies by Pereira et al ( Supplementary Figure S2 ).…”

Section: Resultsmentioning

confidence: 99%

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Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Yang

Pan

Hai

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Posterior long spinal fusion was the common procedure for adult spinal deformity (ASD). Although the application of sacropelvic fixation (SPF), the incidence of pseudoarthrosis and implant failure is still high in long spinal fusion extending to lumbosacral junction (LSJ). To address these mechanical complications, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended. This was the first study to compare the biomechanical performance of combining multiple pelvic screws and multirod construct to other advanced SPF constructs for the augmentation of LSJ in long spinal fusion surgery through finite element (FE) analysis.Methods: An intact lumbopelvic FE model based on computed tomography images of a healthy adult male volunteer was constructed and validated. The intact model was modified to develop five instrumented models, all of which had bilateral pedicle screw (PS) fixation from L1 to S1 with posterior lumbar interbody fusion and different SPF constructs, including No-SPF, bilateral single S2-alar-iliac (S2AI) screw and single rod (SS-SR), bilateral multiple S2AI screws and single rod (MS-SR), bilateral single S2AI screw and multiple rods (SS-MR), and bilateral multiple S2AI screws and multiple rods (MS-MR). The range of motion (ROM) and stress on instrumentation, cages, sacrum, and S1 superior endplate (SEP) in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were compared among models.Results: Compared with intact model and No-SPF, the ROM of global lumbopelvis, LSJ, and sacroiliac joint (SIJ) was decreased in SS-SR, MS-SR, SS-MR, and MS-MR in all directions. Compared with SS-SR, the ROM of global lumbopelvis and LSJ of MS-SR, SS-MR, and MS-MR further decreased, while the ROM of SIJ was only decreased in MS-SR and MS-MR. The stress on instrumentation, cages, S1-SEP, and sacrum decreased in SS-SR, compared with no-SPF. Compared with SS-SR, the stress in EX and AR further decreased in SS-MR and MS-SR. The most significantly decreased ROM and stress were observed in MS-MR.Conclusion: Both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ and reduce stress on instrumentation, cages, S1-SEP, and sacrum. The MS-MR construct was the most adequate to reduce the risk of lumbosacral pseudarthrosis, implant failure, and sacrum fracture. This study may provide surgeons with important evidence for the application of MS-MR construct in the clinical settings.

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Section: Resultsmentioning

confidence: 99%

“…The intradiscal pressure (IDP) of each lumbar segment was compared to the data in a cadaveric test by Hsiao et al ( Hsiao et al, 2022 ). Pure moments of 7.5 Nm with and without an axial load of 500 N in FL, EX, and LB were applied to the superior endplate of L1.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Yang

Pan

Hai

et al. 2023

Front. Bioeng. Biotechnol.

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“…Experimentally, it is difficult to measure the stress within the vertebral body. However, the stress in the intervertebral disc can be measured using the compressive force through the endplate of the vertebral body [ 29 ]. When it comes to compression loading in the spine motion segment, age-related degeneration may lead to a transfer of load from the nucleus to the posterior annulus [ 23 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…A compressive follower load (FL = 500 N) was applied from T12-S1 using a system of eyelets, cables, pulleys, and dead weights to simulate body weight. The experimental setup and procedures were presented in our previous study [29,30]. In our FE model, the results of the range of motion (ROM) of the T12 to L5 vertebral body were predicted by a 7.5 N-m bending moment for flexion, extension, and lateral bending and combined with a 500 N axial load.…”

Section: Validation Of the Fe Modelmentioning

confidence: 99%

Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model

Hsiao,

Tsai

et al. 2023

Bioengineering

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Spinal fusion surgery leads to the restriction of mobility in the vertebral segments postoperatively, thereby causing stress to rise at the adjacent levels, resulting in early degeneration and a high risk of adjacent vertebral fractures. Thus, to address this issue, non-fusion surgery applies some pedicle screw-based dynamic stabilisation systems to provide stability and micromotion, thereby reducing stress in the fusion segments. Among these systems, the hybrid performance stabilisation system (HPSS) combines a rigid rod, transfer screw, and coupler design to offer a semi-rigid fixation method that preserves some mobility near the fusion site and reduces the adjacent segment compensatory effects. However, further research and confirmation are needed regarding the biomechanical effects of the dynamic coupler stiffness of the HPSS on the intrinsic degenerated adjacent segment. Therefore, this study utilised the finite element method to investigate the impact of the coupler stiffness of the HPSS on the mobility of the lumbar vertebral segments and the stress distribution in the intervertebral discs under flexion, extension, and lateral bending, as well as the clinical applicability of the HPSS on the discs with intrinsic moderate and severe degeneration at the adjacent level. The analytical results indicated that, regardless of the degree of disc degeneration, the use of a dynamic coupler stiffness of 57 N/mm in the HPSS may reduce the stress concentrations at the adjacent levels. However, for severely degenerated discs, the postoperative stress on the adjacent segments with the HPSS was still higher compared with that of the discs with moderate degeneration. We conclude that, when the discs had moderate degeneration, increasing the coupler stiffness led to a decrease in disc mobility. In the case of severe disc degeneration, the effect on disc mobility by coupler stiffness was less pronounced. Increasing the coupler stiffness ked to higher stress on intervertebral discs with moderate degeneration, while its effect on stress was less pronounced for discs with severe degeneration. It is recommended that patients with severe degeneration who undergo spinal dynamic stabilisation should remain mindful of the risk of accelerated adjacent segment degeneration.

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Section: Am J Biomed Sci and Resmentioning

confidence: 99%

An Investigation of Revisional Surgery After Implantation of Device for Intervertebral Motion (DIAM): A Case Series Study

2023

AJBSR

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Background: The application of the Device for Intervertebral Assisted Motion (DIAM™) is a spinal fusion device recently and widely development for the treatment of lumbar degenerative diseases. Among the Interspinous Process Devices (IPDs) the Device for Intervertebral Assisted Motion (DIAM™) is a relatively newer fusion technology, based on the placement of a flexible IPD. Purpose: This study was aimed to evaluate the clinical outcome of a widely used IPDs called DIAM™. Methods:The patients (n=44) had undergone DIAM™ placement were evaluated the medical records in our hospital. The demographic data and diagnosis were recorded. Revision surgery was performed for each patient and follow-up was based on medical and radiological records.Results: Forty-four patients with a mean (±SD) age of 58.80(±13.12) years underwent the revision surgery of DIAM™. The complication of patients' previous revision surgery, arranging from low to high was in DIAM™ alone with infection (2 cases), DIAM™ alone with instability (3 cases), preventing Adjacent Segment Disease (ASD) (6 cases), inadequate decompression (30 cases), DIAM™-involved instability with stenosis (34 cases).Conclusions: DIAM™ may not be a comprehensive interspinous process decompression device to treat all kinds of spinal diseases due to its various postoperative complications. The predominant DIAM™ indications would be disc herniation, spinal stenosis, black disc disease, and fusion after ASD (topping Off).

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Biomechanical Effect of Hybrid Dynamic Stabilization Implant on the Segmental Motion and Intradiscal Pressure in Human Lumbar Spine

Cited by 6 publications

References 63 publications

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Biomechanical evaluation of multiple pelvic screws and multirod construct for the augmentation of lumbosacral junction in long spinal fusion surgery

Influence of Simulated State of Disc Degeneration and Axial Stiffness of Coupler in a Hybrid Performance Stabilisation System on the Biomechanics of a Spine Segment Model

An Investigation of Revisional Surgery After Implantation of Device for Intervertebral Motion (DIAM): A Case Series Study

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