Adjacent Segment Mobility After Rigid and Semirigid Instrumentation of the Lumbar Spine

Cakir, Balkan; Carazzo, Charles André; Schmidt, René; Mattes, Thomas; Reichel, Heiko; Käfer, Wolfram

doi:10.1097/brs.0b013e3181a136ab

Cited by 84 publications

(50 citation statements)

References 28 publications

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“…In the present study, the range of motion (ROM) was 69% lower in flexion-extension, 73% lower in bending, and 34% lower in axial rotation in the spines implanted with rods than in the intact spines. [1,3,7,8,14,19,20] Rigid fixation and fusion of the mobile segment alter the biomechanics and kinematics of the entire lumbar spine. [1,3,6,9,14,17,20] The precise relationship between the local stiffness produced by segmental fixation and accelerated degeneration, however, remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…[1,3,7,8,14,19,20] Rigid fixation and fusion of the mobile segment alter the biomechanics and kinematics of the entire lumbar spine. [1,3,6,9,14,17,20] The precise relationship between the local stiffness produced by segmental fixation and accelerated degeneration, however, remains unclear. [1,9,21] In the present study, there was significant variation between the intact spine and the adjacent segment in the axial position.…”

Section: Discussionmentioning

confidence: 99%

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Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

Karakaşlı

Çeçen

Erduran

et al. 2014

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada lomber omurganın rijit tespitinden sonra komşu segmentin hareket genişliği ve stabilitesi araş-tırıldı. Gereç ve yöntemler: Bu çalışmada 17 taze donmuş kuzu lomber omurgası (sakrum T 12 'yi içeren) kullanıl-dı. Biyomekanik test aksiyel kompresyon test cihazı ile yapıldı. Aksiyel kompresyon tüm numunelere 5 mm/dk. yükleme hızı ile uygulandı. Özel dizayn edilmiş fikstür ile 8400 Nmm tork oluşturuldu. Fikstür aksiyel yönde fleksiyon, ekstansiyon, sağ ve sola eğilme pozisyonlarında yüklenme uygulanacak şekilde numuneler ayarlandı. Tüm numuneler sağlam omurga, pedikül vida ve rod fiksasyonu sonrasında teste tabi tutuldu. Test esnasında komşu seviye L5-S1 arasındaki ayrılma değerleri süreğen bir şekilde ekstansometre ile kaydedildi. Bulgular: Komşu segmentte (L5-S1), aksiyel yüklenme ve üst-alt ayrılma değerleri, ön-arka ayrılma değerlerinden düşük bulundu. İstatistiksel analizde sağlam omurga ile komşu segment arasında aksiyel kompresyon ve ekstansiyon pozisyonunda sayısal anlamlı değişiklikler tespit edildi (p<0.027). Bunun yanında ekstansiyon pozisyonunda komşu segmentte sağlam omurgaya göre daha yüksek çıktı (p<0.015). Sonuç: Lomber omurganın rijit fiksasyonu komşu segment seviyesinde hareket genişliğini değiştirmektedir. Bundan dolayı, komşu segmentte anormal stres ve spinal instabiliteye neden olur; bu durum, faset eklem dejenerasyonuna ve bel ağrılarına yol açabilir.Anahtar sözcükler: Komşu segment instabilitesi; faset eklem; omurlar arası disk; lomber omurga.Objectives: This study aims to examine the motion and stability of the adjacent segment following rigid fixation of the lumbar spine. Materials and methods:The study included 17 fresh-frozen lamb lumbar spines (including the sacrum to T 12 ). Biomechanical testing was performed using an axial compression testing machine. Axial compression was applied to all the specimens using a loading speed of 5 mm min-1. A specifically designed fixture was used to generate torque ≤8400 Nmm. The fixture was used with each specimen to achieve flexion and extension, axial neutral compression, and right and left bending. All specimens were tested intact, and again after implantation using posterior pedicle screws and rod fixation. During testing intervertebral displacement at the adjacent level (L5-S1) was recorded continuously via extensometry. Results: Axial compression and superior-inferior displacement were lower in the adjacent segment (L5-S1) than anterior-posterior displacement following rigid fixation. Statistical analysis showed that there was a numerical difference and a significant change between the intact spine and the adjacent segment in the axial compression and extension positions (p<0.027). The intact spines demonstrated the maximum displacement and the difference in extension positions were significant (p<0.015). Conclusion: Rigid fixation of the lumbar spine altered the range of motion at the adjacent segment level. As such, abnormal stress on the adjacent segment causes spinal instability, which may subsequently cause facet joint degen...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

Karakaşlı

Çeçen

Erduran

et al. 2014

Eklem Hastalik Cerrahisi

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show abstract

“…This is in line with the results of a retrospective radiographic analysis by Cakir and colleagues where it was shown that Dynesys stabilization has no significant influence on the adjacent segment range of motion. Obviously preserving motion does not necessarily prevent adjacent segment disease, 21,22 and the natural course of degenerative disease is difficult to predict.…”

Section: Radiologic Outcomementioning

confidence: 99%

Long-term Outcome After Monosegmental L4/5 Stabilization for Degenerative Spondylolisthesis With the Dynesys Device

Hoppe

Schwarzenbach

Aghayev

et al. 2016

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective analysis of prospectively collected clinical data.Objective: To assess the long-term outcome of patients with monosegmental L4/5 degenerative spondylolisthesis treated with the dynamic Dynesys device. Summary of Background Data:The Dynesys system has been used as a semirigid, lumbar dorsal pedicular stabilization device since 1994. Good short-term results have been reported, but little is known about the long-term outcome after treatment for degenerative spondylolisthesis at the L4/5 level.Methods: A total of 39 consecutive patients with symptomatic degenerative lumbar spondylolisthesis at the L4/5 level were treated with bilateral decompression and Dynesys instrumentation. At a mean follow-up of 7.2 years (range, 5.0-11.2 y), they underwent clinical and radiographic evaluation and quality of life assessment.Results: At final follow-up, back pain improved in 89% and leg pain improved in 86% of patients compared with preoperative status. Eighty-three percent of patients reported global subjective improvement. Ninety-two percent would undergo the surgery again. Eight patients (21%) required further surgery because of symptomatic adjacent segment disease (6 cases), lateonset infection (1 case), and screw breakage (1 case). In 9 cases, radiologic progression of spondylolisthesis at the operated segment was found. Seventy-four percent of operated segments showed limited flexion-extension range of <4 degrees. Adjacent segment pathology, although without clinical correlation, was diagnosed at the L5/S1 (17.9%) and L3/4 (28.2%) segments. In 4 cases, asymptomatic screw loosening was observed.Conclusions: Monosegmental Dynesys instrumentation of degenerative spondylolisthesis at L4/5 shows good long-term results. The rate of secondary surgeries is comparable to other dorsal instrumentation devices. Residual range of motion in the stabilized segment is reduced, and the rate of radiologic and symptomatic adjacent segment degeneration is low. Patient satisfaction is high. Dynesys stabilization of symptomatic L4/5 degenerative spondylolisthesis is a possible alternative to other stabilization devices.

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“…3 Миофиксация поясничного отде-ла позвоночника при сгибании (а) и разгибании (б) Рис. 2 Диапазон движений поясничных сегментов, смежных с зоной спондилодеза, у пациентов с поясничным остеохондрозом (а) и дегенеративным поясничным спондилолистезом (б) при сагиттальных движениях позвоночника тах, смежных с артродезированными, с развитием в отдаленном послеопера-ционном периоде клинически значи-мой болезни смежного сегмента [1,2,5,6,9,23,40,44]. Следует отметить отсутствие корреляции между рентге-нологическими признаками дегенера-ции краниального смежного (с зоной спондилодеза) сегмента и клиниче-скими результатами хирургического лечения [31].…”

Section: Discussionunclassified

Кинематика Поясничных Сегментов, Смежных С Инструментальным Ригидным Заднебоковым Спондилодезом

Радченко¹,

Kolesnichenko²,

Конг³

et al. 2014

Хирургия позвоночника 3-2014

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Adjacent Segment Mobility After Rigid and Semirigid Instrumentation of the Lumbar Spine

Cited by 84 publications

References 28 publications

Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

Long-term Outcome After Monosegmental L4/5 Stabilization for Degenerative Spondylolisthesis With the Dynesys Device

Кинематика Поясничных Сегментов, Смежных С Инструментальным Ригидным Заднебоковым Спондилодезом

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