Effect of different designs of interspinous process devices on the instrumented and adjacent levels after double-level lumbar decompression surgery: A finite element analysis

Lo, Hao Ju; Chen, Hung Ming; Kuo, Yi Jie; Yang, Shaojie

doi:10.1371/journal.pone.0244571

Cited by 13 publications

(9 citation statements)

References 32 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among the subtle differences, the BacFuse model has the least extension ROM, and Coflex has the greatest extension in the IPD segment, which indicates that the BacFuse is more restrictive on extension. Implants increased the ROM of adjacent segments and may lead to greater pressure on the back of the intervertebral disc, which is consistent with the study of LoHJ [21] and others. BacFuse has the greatest restriction on both lateral bending and axial rotation, which is related to the way the three devices are fixed in contact with the spinous process and the shape and material of the implant.…”

Section: Discussionsupporting

confidence: 91%

Biomechanical comparison of different interspinous process devices in the treatment of lumbar spinal stenosis: a finite element analysis

Liu

Zhang

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Lumbar spinal stenosis (LSS) is a common disease among elderly individuals, and surgery is an effective treatment. The development of minimally invasive surgical techniques, such as the lumbar interspinous process device (IPD), has provided patients with more surgical options. Objective To investigate the biomechanical properties of different IPDs, including BacFuse, X-Stop and Coflex, in the treatment of LSS. Methods Based on the computed tomography images of a patient with LSS, four finite element (FE) models of L3-S5 were created in this study. The FE models included a surgical model of the intact lumbar spine and surgical models of the lumbar IPDs BacFuse, X-Stop, and Coflex. After validating the models, they were simulated for four physiological motions: flexion, extension, lateral bending and axial rotation, and range of motion (ROM). Stress distribution of discs and facet joints in each segment, stress distribution of the spinous process in the operated section, and stress distribution of the internal fixation were compared and analysed. Results Compared to the model of the intact lumbar spine, the other three models showed a decrease in ROM and disc and facet joint stresses in the surgical segment during movement and an increase in ROM and disc and facet joint stresses in the adjacent segments. These effects were greater for the proximal adjacent segment with BacFuse and more pronounced for the distal adjacent segment with Coflex, while X-Stop had the greatest stress effect on the spinous process in the surgical segment. Conclusion BacFuse, Coflex and X-Stop could all be implemented to effectively reduce extension and disc and facet joint stresses, but they also increase the ROM and disc and facet joint stresses in adjacent segments, which may cause degeneration.

show abstract

Section: Discussionsupporting

confidence: 91%

Biomechanical comparison of different interspinous process devices in the treatment of lumbar spinal stenosis: a finite element analysis

Liu

Zhang

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Lo et al [22] (Fig. 6), indicating that the intact L1-S1 FE model in this study was successfully constructed and can be used for further analysis.…”

Section: Model Validationmentioning

confidence: 55%

“…In this study, the differences between the von Mises stresses of the three meshes were compared by the same method. Second, a 400 N compressive load and 7.5 N-m moments were applied to simulate exion, extension, lateral bending, and rotation, and the ROM (range of motion) of each segment was compared with those of Yamamoto et al [19], Shim et al [20], Huang et al [21], Lo et al [22].…”

Section: Model Validationmentioning

confidence: 99%

Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment： finite element analysis

Kahaer

Zhang

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

Background:: Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF). Methods: Three finite element (FE) models of the L1-S1 lumbar spine, including seven ligaments and facet joint cartilage were established according to the four human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, the von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 N/m moments in flexion, extension, bending, and rotation. Results: BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS has the lowest ROM in flexion and lateral bending. The BMCS-BMCS group showed maximal cage stress in flexion and lateral bending, and the BPS-BPS group in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS group, BPS-BMCS presented a lower risk of screw breakage and BMCS-BPS presented a lower risk of rod breakage. Conclusion: The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.

show abstract

“… 2 Various manufactured IPDs have different degrees of range of motion restriction and stress over the disc at the instrumented level. 6 …”

Section: Introductionmentioning

confidence: 99%

Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments

Krakowiak¹,

Rulewska²,

Rudaś³

et al. 2022

JPR

View full text Add to dashboard Cite

Aim Interspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses. Purpose To evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments. Patients and Methods Twenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments. Results Statistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm 2 . The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)). Conclusion Decompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.

show abstract

Effect of different designs of interspinous process devices on the instrumented and adjacent levels after double-level lumbar decompression surgery: A finite element analysis

Cited by 13 publications

References 32 publications

Biomechanical comparison of different interspinous process devices in the treatment of lumbar spinal stenosis: a finite element analysis

Biomechanical comparison of different interspinous process devices in the treatment of lumbar spinal stenosis: a finite element analysis

Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment： finite element analysis

Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments

Contact Info

Product

Resources

About