Do in vivo kinematic studies provide insight into adjacent segment degeneration? A qualitative systematic literature review

Malakoutian, Masoud; Volkheimer, David; Street, John; Dvorak, Marcel F.; Wilke, Hans–Joachim; Oxland, Thomas R.

doi:10.1007/s00586-015-3992-0

Cited by 61 publications

(33 citation statements)

References 81 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Further, these protocols differ in the assumption on the postoperative motion behavior of the patients. In a parallel review on in vivo kinematics by Malakoutian et al [4], it was shown that the motion of the lumbar spine in patients tends to decrease after fusion in most studies, demonstrating that the notion that patients move the same after fusion as implemented with the stiffness and hybrid protocol does not appear to be correct. The decrease in motion shown in vivo could be predicted by the flexibility protocol.…”

Section: Discussionmentioning

confidence: 97%

“…For fusion procedures, it was shown in a parallel review article by Malakoutian et al that the cranial adjacent segment can be susceptible to the development of hypermobility in some cases, whereas at the inferior segment, either no changes were found or the motion decreased in the sagittal plane [4]. For total disc replacement (TDR) and other flexible implants, compensatory alterations in adjacent segments were seen rarely, apparently corroborating the protective potential of these devices.…”

Section: Introductionmentioning

confidence: 91%

“…A systematic analysis of in vivo kinematic studies by Malakoutian et al [4] showed a partly inconsistent postoperative motion behavior of the patients. Furthermore, it was pointed out that cranial and caudal adjacent segments responded differently to surgical treatments.…”

Section: Biomechanical Premises For the Test Protocolsmentioning

confidence: 99%

See 2 more Smart Citations

Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature

Volkheimer¹,

Malakoutian

Oxland

et al. 2015

Eur Spine J

Self Cite

View full text Add to dashboard Cite

The three test protocols mainly differ in the assumption on the postoperative motion behavior of the patients, which is the main reason for the conflicting findings. However, the protocols have never been validated using in vivo kinematic data. In a parallel review on in vivo kinematics by Malakoutian et al., it was found that the assumption that the patients move exactly the same after fusion implemented with the stiffness- and hybrid protocol does not match the patients' behavior. They showed that the motion of the whole lumbar spine rather tends to decrease in most studies, which could be predicted by the flexibility protocol. However, when the flexibility protocol is used with the "gold standard" pure moment, the difference in the kinematic changes between the cranial and caudal adjacent segment cannot be reproduced, putting the validity of current in vitro protocols into question.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 91%

See 1 more Smart Citation

Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature

Volkheimer¹,

Malakoutian

Oxland

et al. 2015

Eur Spine J

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent review article indicated that this may not represent the loading the DDD patients would experience in daily life and the normal controls and the DDD patients may perform this activity differently 24 . Therefore, future studies of DDD patients should be conducted under loading conditions experienced during typical daily activities such as walking.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension

Thomas

Moore

Liow

et al. 2017

Spine

View full text Add to dashboard Cite

Study Design In vivo patient biomechanical study. Objective To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body. Summary of Background Data LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent non-degenerated LIVFs in DDD patients under physiologic loading conditions are unknown. Methods Nine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was MRI scanned for construction of 3D lumbar vertebral models, and fluoroscopically imaged when the body extended from 45° flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segment L4/5 and L5/S1 were compared with a normal control group at 45° flexion, upright, and full extension of the body. Results The mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (p<0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (p<0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (p>0.05). Conclusion Similar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment. Level of Evidence N/A

show abstract

“…Due to the arthrodesis, motion will be lost at the operated motion segment, reducing the total cervical spine ROM. Thus, even if adjacent segment motion is equivalent after each procedure, motion segments adjacent to arthrodesis will appear to contribute more to the overall spine motion (in terms of percent of the total ROM) than motion segments adjacent to arthroplasty …”

Section: Cervical Spine Kinematicsmentioning

confidence: 99%

Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography

Anderst

2015

Journal Orthopaedic Research

View full text Add to dashboard Cite

Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.

show abstract

Do in vivo kinematic studies provide insight into adjacent segment degeneration? A qualitative systematic literature review

Cited by 61 publications

References 81 publications

Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature

Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature

In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension

Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography

Contact Info

Product

Resources

About