Biomechanical Evaluation of Lumbar Decompression Adjacent to Instrumented Segments

Grunert, Peter; Reyes, Phillip M.; Newcomb, Anna G.; Towne, Sara; Kelly, Brian P.; Theodore, Nicholas; Härtl, Roger

doi:10.1227/neu.0000000000001419

Cited by 20 publications

(11 citation statements)

References 42 publications

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“…Resection of facet joints destabilizes spinal segments proportional to the amount of joint removed (37)(38)(39). Moreover, removal of midline structures further contributes to segmental destabilization (38,40). In order to minimize post decompression instability and subsequent need for arthrodesis surgery, several minimally invasive technique aiming to preserve facet joint function and midline structures have been developed.…”

Section: Discussionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods:We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up.Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3˚ vs. 35.7˚; height: 2.9 vs. 5.7 mm; P<0.01).All patients tolerated endoscopic interlaminar decompression well and half of the patients were discharged on the day of surgery. At last follow-up (12.6±1.7 months), 8 out of 10 patients experienced a minimally clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.2±0.5 preoperatively to 2.5±0.8 postoperatively (P=0.001). The back pain VAS also improved (preoperatively 5.1±1.1 vs. postoperatively 1.7±0.9, P<0.05). The ODI improved from 50±5.8 preoperatively to 22.2±5.1 at last follow-up (P=0.001). One patient experienced persistent leg pain.Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression.

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Section: Discussionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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“…Stability describes the ability to maintain equilibrium despite the presence of kinematic and/or control disturbances. The mechanical stability of lumbar spine is considered an important factor [ 14 ] for ensuring the balance and posture required for normal daily activities such as walking, running, flexion, and extension [ 15 ]. Particularly, lumbar spine instability determines an increased risk of recurrent lumbar spine disc herniation, which, subsequently, often leads to disorders in the lower limbs loading, impairs proprioception and deteriorates postural stability [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Co-contraction characteristics of lumbar muscles in patients with lumbar disc herniation during different types of movement

Omisore

et al. 2018

BioMed Eng OnLine

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BackgroundMuscular performance is an important factor for the mechanical stability of lumbar spine in humans, in which, the co-contraction of lumbar muscles plays a key role. We hypothesized that when executing different daily living motions, the performance of the lumbar muscle co-contraction stabilization mechanism varies between patients with lumbar disc herniation (LDH) and healthy controls. Hence, in this study, co-contraction performance of lumbar muscles between patients with LDH and healthy subjects was explored to check if there are significant differences between the two groups when performing four representative movements.MethodsTwenty-six LDH patients (15 females, 11 males) and a control group of twenty-eight subjects (16 females, 12 males) were recruited. Surface electromyography (EMG) signals were recorded from the external oblique, lumbar multifidus, and internal oblique/transversus abdominis muscles during the execution of four types of movement, namely: forward bending, backward bending, left lateral flexion and right lateral flexion. The acquired EMG signals were segmented, and wavelet decomposition was performed followed by reconstruction of the low-frequency components of the signal. Then, the reconstructed signals were used for further analysis. Co-contraction ratio was employed to assess muscle coordination and compare it between the LDH patients and healthy controls. The corresponding signals of the subjects in the two groups were compared to evaluate the differences in agonistic and antagonistic muscle performance during the different motions. Also, sample entropy was applied to evaluate complexity changes in lumbar muscle recruitment during the movements.ResultsSignificant differences between the LDH and control groups were found in the studied situations (p < 0.05). During the four movements considered in this study, the participants of the LDH group exhibited a higher level of co-contraction ratio, lower agonistic, and higher antagonistic lumbar muscle activity (p < 0.01) than those of the control group. Furthermore, the co-contraction ratio of LDH patients was dominated by the antagonistic muscle activity during the movements, except for the forward bending motion. However, in the healthy control group, the agonistic muscle activity contributed more to the co-contraction ratio with an exception for the backward bending motion. Conversely, the sample entropy value was significantly lower for agonistic muscles of LDH group compared to the control group (p < 0.01) while the entropy value was significantly greater in antagonistic muscles (p < 0.01) during the four types of movement, respectively.ConclusionsLumbar disc herniation patients exhibited numerous variations in the evaluated parameters that reflect the co-contraction of lumbar muscles, the agonistic and antagonistic muscle activities, and their respective sample entropy values when compared with the healthy control group. These variations could be due to the compensation mechanism that was required to stabilize the spine. The resu...

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“…Our biomechanical study revealed that if decompressing a segment adjacent to a simultaneously performed fusion, it is crucial to preserve both facet joints in order to maintain stability. The findings of this study suggested that a mono-segmental MIS-TLIF combined with an adjacent MIS-tubular decompression is superior to a mono-segmental MIS-TLIF with adjacent level open laminectomy (14).…”

Section: Review Of Techniquesmentioning

confidence: 70%

“…On the other hand, a decompression without fusion when performed adjacent to a fused level may be associated with instability and failure (11)(12)(13). In order to assess the biomechanical stability of a simultaneously performed single level MIS-TLIF and decompression without fusion of the adjacent stenotic segment, our group recently performed a biomechanical cadaver study (14). The findings of this particular study suggest that, if done in a minimally invasive fashion, a unilateral laminotomy for bilateral decompression (ULBD) of the adjacent segment causes significantly less motion than a traditional open laminectomy.…”

Section: Review Of Techniquesmentioning

confidence: 99%

“One and a half” minimally invasive transforaminal lumbar interbody fusion: single level transforaminal lumbar interbody fusion with adjacent segment unilateral laminotomy for bilateral decompression for spondylolisthesis with bisegmental stenosis

et al. 2018

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Symptomatic lumbar spondylolisthesis is commonly accompanied by spinal stenosis in multiple segments. These pathologies are routinely treated by multilevel decompression and instrumented fusion. However, it was hypothesized that a minimally invasive surgery (MIS) fusion in the unstable segment combined with a unilateral laminotomy for bilateral decompression (ULBD) in the adjacent stenotic segment is a biomechanically feasible alternative to a two-level fusion and superior to open laminectomy adjacent to a fused segment. This concept has demonstrated success in a recently published biomechanical cadaver study performed by our group. The present article offers a detailed step by step technical description for an MIS-TLIF (transforaminal lumbar interbody fusion) with adjacent ULBD.

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Biomechanical Evaluation of Lumbar Decompression Adjacent to Instrumented Segments

Abstract: MI, minimally invasive.

Cited by 20 publications

References 42 publications

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Co-contraction characteristics of lumbar muscles in patients with lumbar disc herniation during different types of movement

“One and a half” minimally invasive transforaminal lumbar interbody fusion: single level transforaminal lumbar interbody fusion with adjacent segment unilateral laminotomy for bilateral decompression for spondylolisthesis with bisegmental stenosis

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