The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine

Fujiwara, Atsushi; Lim, Tae-Hong; An, Howard S.; Tanaka, Nobuhiro; Jeon, Chang-Hoon; Andersson, Gunnar; Haughton, Victor M.

doi:10.1097/00007632-200012010-00011

Cited by 522 publications

(416 citation statements)

References 47 publications

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“…The motion restriction obtained with the UC affected all three planes, even though this reduction failed to achieve significance in lateral bending and axial rotation. This finding, not observed with the Wallis, is of great interest since Fujiwara et al showed that axial rotation was most affected by disc degeneration, leading to increased ROM with mild and intermediate degeneration [27]. No significant additional motion was observed with either of the implants at the adjacent segments, suggesting a possibly reduced risk of ASD compared to fusion.…”

Section: Discussionmentioning

confidence: 77%

Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

et al. 2010

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Treatment of chronic low back pain due to degenerative lumbar spine conditions often involves fusion of the symptomatic level. A known risk of this procedure is accelerated adjacent level degeneration. Motion preservation devices have been designed to provide stabilization to the symptomatic motion segment while preserving some physiologic motion. The aim of this study was to compare the changes in relative range of motion caused as a result of application of two non-fusion, dynamic stabilization devices: the Universal Clamp (UC) and the Wallis device. Nine fresh, frozen human lumbar spines (L1-Sacrum) were tested in flexion-extension, lateral bending, and axial rotation with a custom spine simulator. Specimens were tested in four conditions: (1) intact, (2) the Universal Clamp implanted at L3-4 (UC), (3) the UC with a transverse rod added (UCTR), and (4) the Wallis device implanted at L3-4. Total range of motion at 7.5 N-m was determined for each device and compared to intact condition. The UC device (with or without a transverse rod) restricted motion in all planes more than the Wallis. The greatest restriction was observed in flexion. The neutral position of the L3-4 motion segment shifted toward extension with the UC and UCTR. Motion at the adjacent levels remained similar to that observed in the intact spine for all three constructs. These results suggest that the UC device may be an appropriate dynamic stabilization device for degenerative lumbar disorders.

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Section: Discussionmentioning

confidence: 77%

Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

et al. 2010

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“…Fujiwara et al [8] found that changes in the ROM due to segmental degeneration differs in the three main motion planes. They found axial rotation to be mostly affected by degeneration and reported an increase in motion due to degeneration.…”

Section: Discussionmentioning

confidence: 99%

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

et al. 2009

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In advanced stages of degenerative disease of the lumbar spine instrumented spondylodesis is still the golden standard treatment. However, in recent years dynamic stabilisation devices are being implanted to treat the segmental instability due to iatrogenic decompression or segmental degeneration. The purpose of the present study was to investigate the stabilising effect of a classical pedicle screw/rod combination, with a moveable hinge joint connection between the screw and rod allowing one degree of freedom (cosmicMIA). Six human lumbar spines (L2-5) were loaded in a spine tester with pure moments of ±7.5 Nm in lateral bending, flexion/extension and axial rotation. The range of motion (ROM) and the neutral zone were determined for the following states: (1) intact, (2) monosegmental dynamic instrumentation (L4-5), (3) bisegmental dynamic instrumentation (L3-5), (4) bisegmental decompression (L3-5), (5) bisegmental dynamic instrumentation (L3-5) and (6) bisegmental rigid instrumentation (L3-5). Compared to the intact, with monosegmental instrumentation (2) the ROM of the treated segment was reduced to 47, 40 and 77% in lateral bending, flexion/ extension and axial rotation, respectively. Bisegmental dynamic instrumentation (3) further reduced the ROM in L4-5 compared to monosegmental instrumentation to 25% (lateral bending), 28% (flexion/extension) and 57% (axial rotation). Bisegmental surgical decompression (4) caused an increase in ROM in both segments (L3-4 and L4-5) to approximately 125% and approximately 135% and 187-234% in lateral bending, flexion/extension and axial rotation, respectively. Compared to the intact state, bisegmental dynamic instrumentation after surgical decompression reduced the ROM of the two-bridged segments to 29-35% in lateral bending and 33-38% in flexion/extension. In axial rotation, the ROM was in the range of the intact specimen (87-117%). A rigid instrumentation (6) further reduced the ROM of the two-bridged segments to 20-30, 23-27 and 50-68% in lateral bending, flexion/ extension and axial rotation, respectively. The results of the present study showed that compared to the intact specimen the investigated hinged dynamic stabilisation device reduced the ROM after bisegmental decompression in lateral bending and flexion/extension. Following bisegmental decompression and the thereby caused large rotational instability the device is capable of restoring the motion in axial rotation back to values in the range of the intact motion segments.

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“…Another important cause of axial back pain is facet joint osteoarthritis, which consists in the decrease of the thickness and regularity of the cartilage layer of the facet joints, also called apophyseal or zygoapophysial joints. Disc degeneration and facet joint osteoarthritis are commonly observed together in the same patient and spinal level [20,26,35] and a possible correlation between these two pathologies is currently debated [62].…”

Section: Discogenic Painmentioning

confidence: 99%

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

et al. 2014

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Purpose Degeneration of the intervertebral disc is associated with various morphological changes of the disc itself and of the adjacent structures, such as reduction of the water content, collapse of the intervertebral space, disruption and tears, and osteophytes. These morphological changes of the disc are linked to alterations of the spine flexibility. This paper aims to review the literature about the ageing and degenerative changes of the intervertebral disc and their link with alterations in spinal biomechanics, with emphasis on flexibility. Methods Narrative literature review. Results Clinical instability of the motion segment, usually related to increased flexibility and hypothesized to be connected to early, mild disc degeneration and believed to be responsible for low back pain, was tested in numerous in vitro studies. Despite some disagreement in the findings, a trend toward spinal stiffening with the increasing degeneration was observed in most studies. Tests about tears and fissures showed inconsistent results, as well as for disc collapse and dehydration. Vertebral osteophytes were found to be effective in stabilizing the spine in bending motions. Conclusions The literature suggests that the degenerative changes of the intervertebral disc and surrounding structures lead to subtle alteration of the mechanical properties of the functional spinal unit. A trend toward spinal stiffening with the increasing degeneration has been observed in most studies.

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The Effect of Disc Degeneration and Facet Joint Osteoarthritis on the Segmental Flexibility of the Lumbar Spine

Cited by 522 publications

References 47 publications

Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility

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