Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw–based dynamic fixator

Lee, Young Moo; Kim, Young Eun; Lee, Hak Joong; Kim, Dong Gyu; Kim, Chi Heon

doi:10.3171/2017.3.spine161169

Cited by 37 publications

(28 citation statements)

References 40 publications

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“…In general, the greater the strength of internal fixation, the more likely the adjacent segments are unstable and degenerate [13]. After adopting CAPSI in osteoporotic vertebral body, the fixation effect is obviously better than CPS, and the activity of the surgical segment become smaller, which leads to the compensatory increase of the upper and lower vertebral body movement range of the surgical segments, and results in increased stress on adjacent segmental intervertebral discs as well as facet joints followed by the accelerating degeneration of adjacent segments.…”

Section: Discussionmentioning

confidence: 99%

“…At present, the cause of ASD remains unclear. Some scholars believe that internal fixation will accelerate the degeneration of adjacent segments, which is an independent risk factor for ASD [13], while some studies believe that the occurrence of ASD is mainly related to the age of patients and the type of surgery they undergo. There are many factors related to the degeneration of the intervertebral disc in the anterior adjacent segment, and internal fixation is not the main cause of ASD [14].…”

Section: Introductionmentioning

confidence: 99%

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Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Zhou

Zeng

et al. 2020

J Orthop Surg Res

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To compare the effect of conventional pedicle screw (CPS) and cement-augmented pedicle screw instrumentation (CAPSI) on adjacent segment degeneration (ASD). Methods: A normal male volunteer without a history of spinal disease was selected, lumbar CT data was collected, an intact L3-S1 three-dimensional finite element model was created by software including Mimics, Geomagic, and SolidWorks, and the fixation methods were performed accordingly. A common pedicle screw model and a cementaugmented pedicle screw model of L4-L5 with fusion and internal fixation were constructed. With ANSYS Workbench 17.0, a 500 N load was applied to the upper surface of L3 to simulate the weight of a human body, and a 7.5 N m moment was applied at the neutral point to simulate flexion, extension, left/right bending, left/right rotation of the spine. The peak von Mises stress of intervertebral disc and the range of motion (ROM) on the adjacent segments (L3-4 and L5-S1) were compared. Results: The validity of the intact model shows that the ROM of the model is similar to that of a cadaveric study. Compared with the intact model, CPS model and CAPSI model in all motion patterns increased the ROM of adjacent segments. The intervertebral disc stress and the ROM of adjacent segments were found to be higher in the CAPSI model than in the CPS model, especially in L3-4. Conclusion: In general, the biomechanical analysis of an osteoporotic lumbar spine showed that both CPS and CAPSI can increase the ROM and disc stresses of osteoporotic lumbar models, and compared with CPS, CAPSI is more likely to increase the potential risk of adjacent segment degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Zhou

Zeng

et al. 2020

J Orthop Surg Res

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“…37,38 Dynamic stabilization techniques do not appear be clearly protective against adjacent segment disease, although biomechanical models suggest that they may do so. 33,39,40 A review by Wang and colleagues pooled studies to assess the risk of lumbar adjacent segment disease in spinal fusion to compare to disc arthroplasty and concluded that fusion carried a higher risk of adjacent segment disease. 41 Definitive data on other types of motion preservation devices is lacking.…”

Section: Adjacent Segment Diseasementioning

confidence: 99%

Lumbar Fusion With Polyetheretherketone Rods Use for Patients With Degenerative Disease

Ross¹,

Ross²

2021

Federal Practitioner

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Polyetheretherketone (PEEK) rods for lumbar fusion have been available since 2007. However, literature about their utility is sparse and of mixed outcomes. Methods: A retrospective review of PEEK rod lumbar fusion cases was performed. Data were analyzed from 108 patients of the senior author Donald Ross who underwent PEEK lumbar fusion. Results: There were 97 single and 11 2-level fusions. Rates of tobacco use, diabetes mellitus, low bone density, depression, and immunosuppression were 23.1%, 24.1%, 14.8%, 32.4%, and 6.5%, respectively. In the study population, the mean age was 60.2 years, body mass index was 30.1, and there was a mean 31.3 months for follow-up. There were no wound infections or new neurologic deficits. Of 81 patients with > 11 months of follow-up, 70 (86.4%) had an arthrodesis, 8 (9.9%) had no ar-throdesis, and 3 (3.7%) were indeterminate. No patients had revision fusion surgery and 2 patients had adjacent level fusions at 27 and 60 months. One patient had an adjacent segment laminectomy at 18 months and one a foraminotomy at 89 months, resulting in a 3.7% adjacent segment surgery rate. Mean preoperative Short Form-36 (SF-36) physical functioning (PF) score and Oswestry Disability Index (ODI) score were 28.9 and 24.8, respectively. Mean SF-36 PF postoperative score at 1 and 2 years were 59.3 and 65, respectively. Mean ODI postoperative score at 1 year was 14.5. Conclusions:In a large patient cohort lumbar fusion with PEEK rods can be undertaken with low complication rates, satisfactory clinical improvements, low rates of hardware failure or need for revision surgery. Longer follow-up is needed to confirm findings.

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“…Pedicle screw fixation in lumbar intervertebral fusion procedures is considered to be the current gold standard treatment. By providing increased rigidity in all three main motion directions, the transpedicular stabilisation allows wide decompression in severe lumbar degenerative diseases with moderate to excellent clinical success [2,3]. However, pedicle screw instrumentation comes at the cost of high invasiveness.…”

Section: Introductionmentioning

confidence: 99%

Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures

Spicher

Schmoelz

Schmid

et al. 2020

Biomedical Engineering / Biomedizinische Technik

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In the last decades, several interspinous process devices were designed as a minimally invasive treatment option for spinal stenosis. In order to minimise surgical trauma, interspinous process devices were recently discussed as an alternative posterior fixation in vertebral interbody fusions. Therefore, the purpose of this study was to evaluate the effect of a newly designed interspinous device with polyester bands (PBs) on range of motion (RoM) and centre of rotation (CoR) of a treated motion segment in comparison with an established interspinous device with spikes (SC) as well as with pedicle screw instrumentation in lumbar fusion procedures. Flexibility tests with an applied pure moment load of 7.5 Nm were performed in six monosegmental thoracolumbar functional spinal units (FSUs) in the following states: (a) native, (b) native with PB device, (c) intervertebral cage with PB device, (d) cage with SC and (e) cage with internal fixator. The resulting RoM was normalised to the native RoM. The CoR was determined of X-ray images taken in maximal flexion and extension during testing. In flexion and extension, the PB device without and with the cage reduced the RoM of the native state to 58% [standard deviation (SD) 17.8] and 53% (SD 15.7), respectively. The SC device further reduced the RoM to 27% (SD 16.8), while the pedicle screw instrumentation had the most reducing effect to 17% (SD 17.2) (p < 0.01). In lateral bending and axial rotation, the interspinous devices had the least effect on the RoM. Compared to the native state, for all instrumentations the CoR showed a small shift towards cranial. In the anterior-posterior direction, the SC device and the pedicle screw instrumentation shifted the CoR towards the posterior wall. The interspinous devices significantly reduced the RoM in flexion/extension, while in axial rotation and lateral bending only the internal fixator had a significant effect on the RoM.

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Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw–based dynamic fixator

Cited by 37 publications

References 40 publications

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Lumbar Fusion With Polyetheretherketone Rods Use for Patients With Degenerative Disease

Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures

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