The effect of disc degeneration on anterior shear translation in the lumbar spine

Melnyk, Angela D.; Kelly, Adrienne; Chak, Jason D.; Wen, Tianlin; Cripton, Peter A.; Dvorak, Marcel F.; Oxland, Thomas R.

doi:10.1002/jor.22792

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…Undoubtedly, numerous factors are contributed to low back pain; mechanical causes of low back pain include degenerative spinal pathologies such as spondylolisthesis, disc herniation, discogenic pain, and so on. Although the study by Melnyk et al has dramatically improved our knowledge about the effect of disc degeneration on anterior translation of the lumbar spine under shear loading, we do not completely agree with the conclusion indicating that disc degeneration, as classified with the Pfirrmann scale, does not predict lumbar spinal motion in shear.…”

contrasting

confidence: 87%

“…Further, lumbar disc degeneration is found most often at the L5-S1 level. 5 We believe that the study by Melnyk et al 1 has some important limitations. For example, the study only investigated the L3-4 and L4-5 levels that they did not take the other lumbar levels into account, especially the L5-S1 level.…”

mentioning

confidence: 93%

“…In addition, the in‐vivo studies have reported that different abnormal vertebral motions are closely associated with different lumbar disc degenerations graded by Pfirrmann's criteria . The conclusion of Melnyk et al may mislead the surgeons on the operative treatment options of lumbar disc degeneration.…”

mentioning

confidence: 99%

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The effect of disc degeneration on anterior shear translation in the lumbar spine: Still more problems lie ahead

Shen

Peng

Dai

et al. 2016

Journal Orthopaedic Research

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Letter to Dr. Linda Sandell:Low back pain is the single most common cause for disability in individuals aged 45 years or younger and as a result carries tremendous weight in socioeconomic considerations. Undoubtedly, numerous factors are contributed to low back pain; mechanical causes of low back pain include degenerative spinal pathologies such as spondylolisthesis, disc herniation, discogenic pain, and so on. Although the study by Melnyk et al.1 has dramatically improved our knowledge about the effect of disc degeneration on anterior translation of the lumbar spine under shear loading, we do not completely agree with the conclusion indicating that disc degeneration, as classified with the Pfirrmann scale, does not predict lumbar spinal motion in shear.First, recent biomechanical studies have revealed distinct behavior at the different lumbar levels 2 ; and the study of lumbar intervertebral disc morphology using MR images has shown segment-dependent geometric features.3 Moreover, different clinical outcomes following surgical treatment at the different lumbar levels have been reported. 4 Various factors could influence segmentdependent function of the lumbar spine, such as the surrounding ligaments and muscles, vertebral geometries, the orientation of facet joints, and so on. Notably, the segment-dependent discrepancy may be an inherent factor on the effect of disc degeneration on anterior translation of the lumbar spine under shear loading, which specifically compared at different segment levels are necessary. Further, lumbar disc degeneration is found most often at the L5-S1 level. 5 We believe that the study by Melnyk et al.1 has some important limitations. For example, the study only investigated the L3-4 and L4-5 levels that they did not take the other lumbar levels into account, especially the L5-S1 level. Finally, the in-vitro study applied shear loading conditions could be quite different from in-vivo shear loading conditions, which the surrounding ligaments and muscles are not considered. In addition, the in-vivo studies have reported that different abnormal vertebral motions are closely associated with different lumbar disc degenerations graded by Pfirrmann's criteria. 6 The conclusion of Melnyk et al.1 may mislead the surgeons on the operative treatment options of lumbar disc degeneration.In the end, we unanimously applaud Melnyk et al. for their significant work and the diligence with which they handled this controversial topic. Currently, it is still more problems waiting to be solved. Therefore, substantial work to determine the effect of disc degeneration on anterior translation of the lumbar spine under shear loading is essential in the near future. AUTHORS' CONTRIBUTIONSYS made substantial contributions to manuscript drafting and approval. DP made substantial contributions to revising the manuscript critically for important intellectual content and approval. ZD made substantial contributions to manuscript revision and approval. WZ made substantial contributions to Conception and design of the ...

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The effect of disc degeneration on anterior shear translation in the lumbar spine: Still more problems lie ahead

Shen

Peng

Dai

et al. 2016

Journal Orthopaedic Research

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“…( 223) Some support exists for an association between abnormal translation and facet degeneration (206, 224) Disc degeneration alone may not result in abnormal sagittal plane shear translation. (225,226) There is currently only limited evidence of an association between abnormal RDT and symptoms. ( 13) This is understandable given the lack of a validated test for abnormal RDTs.…”

Section: Rotation Dependent Translation (Rdt)mentioning

confidence: 99%

The challenge of diagnosing lumbar segmental instability

Hipp,

Reitman,

Chaput

et al. 2023

Preprint

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Background Lumbar spinal instability is very commonly discussed in research studies and is routinely used in clinical practice to make treatment decisions. That practice must be reconciled with expert consensus in the peer-reviewed literature: there is currently no validated diagnostic test for spinal instability. Some treatments for instability can have serious complications, so correct diagnosis is important. Biomechanically rational and clinically effective diagnostic tests for instability are needed, where instability is defined as incompetence of the intervertebral motion restraints forming the passive part of the motion control system.Methods This study critically examines and identifies deficiencies in previously employed metrics and criteria for diagnosing spinal instability. New metrics are described that account for the deficiencies. The new metrics were retrospectively applied to 7621 lumbar spine flexion-extension studies to document the prevalence of abnormalities in different patient populations.Results Traditional measurements, such as intervertebral rotation or translation, may fail to find abnormalities in intervertebral motion due to factors such as inconsistent patient effort and radiographic magnification. The proposed biomechanically grounded metrics for lumbar spine sagittal plane shear and vertical instability appear more adept at finding abnormalities in patient populations where abnormalities might be expected and not in patients where instability would not be expected.Discussion New approaches to detecting abnormal sagittal plane intervertebral motion may lead to enhanced and standardized diagnosis of lumbar spine instability. Further clinical research is imperative to validate the efficacy of these metrics in diagnosis and treatment algorithms.

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Moderately degenerated lumbar motion segments: Are they truly unstable?

Rijsbergen

Barthelemy

Vrancken

et al. 2016

Biomech Model Mechanobiol

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The two main load bearing tissues of the intervertebral disc are the nucleus pulposus and the annulus fibrosus. Both tissues are composed of the same basic components, but differ in their organization and relative amounts. With degeneration, the clear distinction between the two tissues disappears. The changes in biochemical content lead to changes in mechanical behaviour of the intervertebral disc. The aim of the current study was to investigate if well-documented moderate degeneration at the biochemical and fibre structure level leads to instability of the lumbar spine. By taking into account biochemical and ultrastructural changes to the extracellular matrix of degenerating discs, a set of constitutive material parameters were determined that described the individual tissue behaviour. These tissue biomechanical models were then used to simulate dynamic behaviour of the degenerated spinal motion segment, which showed instability in axial rotation, while a stabilizing effect in the other two principle bending directions. When a shear load was applied to the degenerated spinal motion segment, no sign of instability was found. This study found that reported changes to the nucleus pulposus and annulus fibrosus matrix during moderate degeneration lead to a more stable spinal motion segment and that such biomechanical considerations should be incorporated into the general pathophysiological understanding of disc degeneration and how its progress could affect low back pain and its treatments thereof.

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The effect of disc degeneration on anterior shear translation in the lumbar spine

Cited by 5 publications

References 43 publications

The effect of disc degeneration on anterior shear translation in the lumbar spine: Still more problems lie ahead

The effect of disc degeneration on anterior shear translation in the lumbar spine: Still more problems lie ahead

The challenge of diagnosing lumbar segmental instability

Moderately degenerated lumbar motion segments: Are they truly unstable?

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