The influence of spinal fusion length on proximal junction biomechanics: a parametric computational study

Ignasiak, Dominika; Peteler, Tobias; Fekete, Tamás; Haschtmann, Daniel; Ferguson, Stephen J.

doi:10.1007/s00586-018-5700-3

Cited by 18 publications

(9 citation statements)

References 37 publications

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“…Clearly, PJK is a multifactorial problem where the health of the surrounding musculature, especially those in the thoracic spine, is important. 43,44 Given that paraspinal musculature in the thorax plays a vital role Figure 1E). The seated posture was achieved by seating each subject on the scan table where the backrest was setup 90 relative to its seat ( Figure 1F).…”

Section: Introductionmentioning

confidence: 99%

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Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright openMRI

Zhang

Street

et al. 2021

JOR Spine

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Objective: Spinal-muscle morphological differences between weight-bearing and supine postures have potential diagnostic, prognostic, and therapeutic applications. While the focus to date has been on cervical and lumbar regions, recent findings have associated spinal deformity with smaller paraspinal musculature in the thoracic region. We aim to quantitatively investigate the morphology of trapezius (TZ), erector spinae (ES) and transversospinalis (TS) muscles in upright postures with open upright MRI and also determine the effect of level and posture on the morphological measures. Methods: Six healthy volunteers (age 26 ± 6 years) were imaged (0.5 T MROpen, Paramed, Genoa, Italy) in four postures (supine, standing, standing with 30 flexion, and sitting). Two regions of the thorax, middle (T4-T5), and lower (T8-T9), were scanned separately for each posture. 2D muscle parameters such as cross-sectional area (CSA) and position (radius and angle) with respect to the vertebral body centroid were measured for the three muscles. Effect of spinal level and posture on muscle parameters was examined using 2-way repeated measures ANOVA separately for T4-T5 and T8-T9 regions.

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Section: Introductionmentioning

confidence: 99%

“…Furthermore, clinical studies by Yagi et al 42 suggested that 41% of patients post lumbar degenerative scoliosis surgery, developed progressive global kyphosis in the thorax. Clearly, PJK is a multifactorial problem where the health of the surrounding musculature, especially those in the thoracic spine, is important 43,44 …”

Section: Introductionmentioning

confidence: 99%

Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright openMRI

Zhang

Street

et al. 2021

JOR Spine

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“…[2][3][4][5][6] A plethora of literature exists on the clinical and radiographic risk factors for PJK. 3,[7][8][9][10][11][12][13][14][15][16][17][18] However, prevention of PJK remains unsolved and is still a relatively common postoperative complication.…”

Section: Introductionmentioning

confidence: 99%

Can Machine Learning Accurately Predict Postoperative Compensation for the Uninstrumented Thoracic Spine and Pelvis After Fusion From the Lower Thoracic Spine to the Sacrum?

Lee

Sardar

Boddapati

et al. 2020

Global Spine Journal

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Study Design: Consecutively collected cases. Objective: To determine if a machine-learning (ML) program can accurately predict the postoperative thoracic kyphosis through the uninstrumented thoracic spine and pelvic compensation in patients who undergo fusion from the lower thoracic spine (T10 or T11) to the sacrum. Methods: From 2015 to 2019, a consecutive series of adult (≥18 years old) patients with adult spinal deformity underwent corrective spinal fusion from the lower thoracic spine (T10 or T11) to the sacrum. Deidentified data was processed by a ML system-based platform to predict the postoperative thoracic kyphosis (TK) and pelvic tilt (PT) for each patient. To validate the ML model, the postoperative TK (T4-T12, instrumented thoracic, and uninstrumented thoracic) and the pelvic tilt were compared against the predicted values. Results: A total of 20 adult patients with a minimum 6-month follow-up (mean: 22.4 ± 11.3 months) were included in this study. No significant differences were observed for TK (predicted 37.6° vs postoperative 38.3°, P = .847), uninstrumented TK (predicted 33.9° vs postoperative 29.8°, P = .188), and PT (predicted 23.4° vs postoperative 22.7°, P = .754). The predicted PT and the TK of the uninstrumented thoracic spine correlated well with postoperative values (uninstrumented TK: R 2 = 0.764, P < .001; PT: R 2 = 0.868, P < .001). The mean error with which kyphosis through the uninstrumented thoracic spine can be measured was 4.8° ± 4.0°. The mean error for predicting PT was 2.5° ± 1.7°. Conclusion: ML algorithms can accurately predict the spinopelvic compensation after spinal fusion from the lower thoracic spine to the sacrum. These findings suggest that surgeons may be able to leverage this technology to reduce the risk of proximal junctional kyphosis in this population.

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“…This has even been shown to cause kyphosis or failure of the proximal junction. 19,20 In this experiment, the increase in the displacement of the adjacent segments after multisegment fixation under external force loading can also be explained by the stress concentration theory. 21 This means that when one or more spinal segments are fixed, the amount of deformation of the fixed segment will decrease or disappear and can only be transferred to the upper and lower segments.…”

Section: The Influence Of Different Fixed Lumbar Vertebrae Segments On Adjacent Segmentsmentioning

confidence: 68%

Upper and lower adjacent segment range of motion after fixation of different lumbar spine segments in the goat: an in vitro experiment

Xiao

Wei

et al. 2021

J Int Med Res

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Objectives The purpose of this study was to examine the biomechanical effects of fixation on range of motion (ROM) in the upper and lower adjacent segments of different lumbar spine segments in a goat spine model. Methods Fifteen goat spine specimens (vertebrae T12–S1) were randomly divided into three groups: A (single-segment fixation), B (double-segment fixation), and C (triple-segment fixation). Motion in different directions was tested using a spinal motion simulation test system with five external loading forces. Transverse, forward–backward, and vertical displacement of the upper and lower adjacent segments were measured. Results As the external load increased, the upper and lower adjacent segment ROM increased. A significantly greater ROM in group C compared with group A was found when the applied external force was greater than 75 N. The upper adjacent segment showed a significantly greater ROM than the lower adjacent segment ROM within each group. Conclusions Adjacent segment ROM increased with an increasing number of fixed lumbar segments. The upper adjacent segment ROM was greater than that of the lower adjacent segments. Adjacent segment stability after lumbar internal fixation worsened with an increasing number of fixed segments.

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The influence of spinal fusion length on proximal junction biomechanics: a parametric computational study

Cited by 18 publications

References 37 publications

Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright openMRI

Preliminary investigation of spinal level and postural effects on thoracic muscle morphology with upright openMRI

Can Machine Learning Accurately Predict Postoperative Compensation for the Uninstrumented Thoracic Spine and Pelvis After Fusion From the Lower Thoracic Spine to the Sacrum?

Upper and lower adjacent segment range of motion after fixation of different lumbar spine segments in the goat: an in vitro experiment

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