Kinematic Evaluation of Lumbar Fusion Techniques

Esses, Stephen I.; Doherty, Brian J.; Crawford, Matthew J.; Dreyzin, Vadim

doi:10.1097/00007632-199603150-00003

Cited by 75 publications

(22 citation statements)

References 19 publications

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“…There is a controversy regarding the risk factors involved in the development of ASD [2,11,12,22,28,40,41,47,[57][58][59]. Non-rigid, dynamic or flexible instrumentations for lumbar spine have been developed to reduce ASD [17,18,27].…”

Section: Introductionmentioning

confidence: 99%

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related reoperation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentationmatched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade \II, while the exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration[UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2-4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65? 13 and 64? 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6 months. The instrumented levels averaged 2.5 ? 1 vertebra for both groups. All 45 spines showed radiological fusion 8-12 months postoperatively. Lumbar lordosis did not change postoperatively. Postoperatively at the first cephalad adjacent segment: DH increased in the group W (P = 0.042); ROM significantly increased only in group C (ANOVA, P \ 0.02); olisthesis decreased both in flexion (P = 0.0024) and extension (P = 0.012) in group W. The degeneration or deterioration of already existed ASD in the two cephalad segments was shown in 1 (4.1%) and 6 (28.6%) spines in W and C groups, respectively. Physical function (SF-36) and ODI improved postoperatively (P \ 0.001), but in favour of the patients of group W (P \ 0.05) at the final evaluation. Symptomatic ASD required surgical intervention was in 3 (14%) patients of group C and none in group W. ASD remains a significant problem and accounts for a big portion of revision surgery following instrumented lumbar fusion. In this series, the Wallis interspinous implant changed the natural history of ASD and saved th...

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Section: Introductionmentioning

confidence: 99%

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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“…It has been shown many times, that when certain conditions are fulfilled and if we comprehend that there are certain limits (the exclusion of the influence of the muscles on spinal stabilization), these results are reliably applicable in vivo 8,9 . Tests are carried out on samples of animal spines 2,6 or on human cadaverous spine samples 1,3,4,5,7,11,12 where results are always more precise. That is why our study too uses human spine samples.…”

Section: Discussionmentioning

confidence: 99%

“…With reference to the literature 3,4,5,6,7 there are biomechanical characteristics of the sample which can be characterized as so-called rigidity. The rigidity, T c , of the sample under a pressure load is defined by the following relationship:…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Study of Various Surgical Fixation Methods as Tested on Cadaverous Human Lumbar Spine Samples

Charamza¹,

Hrabálek²,

Keprt³

et al. 2000

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…A possible disadvantage of any combined anterior plus posterior fusion technique is that it leads to increased motion at contiguous levels, but a circumferential fusion does not appear to be worse in this respect than an anterior fusion alone [6]. A further "inconvenience" is the postoperative restriction imposed by 6 weeks in a hip spica.…”

Section: Discussionmentioning

confidence: 99%

Spinal fusion: A combined anterior and supplementary interspinous technique

Fidler

1997

Eur Spine J

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"Standard", noninstrumented, techniques of anterior interbody fusion are frequently followed by nonunion and collapse of the intervertebral space, probably because of persistent rocking movements, particularly in the sagittal plane. Elimination of these theoretical movements by supplementing an anterior interbody fusion with a posterior interspinous H-graft and a cerclage wire was considered to be biomechanically attractive without having the disadvantages associated with posterior instrumentation. In a prospective study a solid fusion was obtained at 16 of 17 operated Ievels, with a mediocre (+ 50%) fusion as the exception. The height of the intervertebral space was increased at the majority of the fused levels. The technique is only applicable where neural arches are intact. The technique proved to be safe, simple, effective and inexpensive.

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Kinematic Evaluation of Lumbar Fusion Techniques

Abstract: There are major biomechanical differences between different fusion techniques. This information should be considered in patients undergoing lumbar spinal fusion.

Cited by 75 publications

References 19 publications

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Biomechanical Study of Various Surgical Fixation Methods as Tested on Cadaverous Human Lumbar Spine Samples

Spinal fusion: A combined anterior and supplementary interspinous technique

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