Global and segmental kinematic changes following sequential resection of posterior osteoligamentous structures in the lumbar spine: An in vitro biomechanical investigation using pure moment testing protocols

Chamoli, Uphar; Korkusuz, Mert H; Sabnis, Ashutosh B; Manolescu, A; Tsafnat, Naomi; Diwan, Ashish D.

doi:10.1177/0954411915612503

Cited by 9 publications

(5 citation statements)

References 48 publications

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“…Neurological symptoms and disability also improved The facet joints and posterior paraspinal muscles maintain the stability of the posterior spine. Biomechanics studies have shown that damage to the facet joint complex by surgery should not exceed 50%, otherwise it would cause instability of the spine [17]. This is the concept of MI spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Yu,

Zheng

2024

Medicine Advances

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BackgroundThe aims of this paper are to introduce Open spinal endoscopy (OSE), which is a new single hole split‐type spinal endoscopic technique that can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex, and to determine whether it can be widely performed.MethodsData from 58 patients who were treated for lumbar disc herniation using the open spinal endoscopic technique at Anhui No. 2 Provincial People's Hospital between July, 2021 and February, 2022 were retrospectively analyzed. Pain in the lower back and legs was evaluated using the visual analog scale (VAS) score, neurologic status by the Japanese Orthopedic Association (JOA) score, and degree of disability by the Oswestry Disability Index (ODI). These evaluations were performed on the day before surgery and at the final postoperative follow‐up. Surgical outcomes were assessed using the modified MacNab criteria. The method described by Dohzono and Matsumura was used to evaluate facet joint preservation.ResultsAfter surgery, the VAS score decreased from 8.4 ± 3.1 to 0.8 ± 0.8 (p < 0.005) for leg pain and from 5.4 ± 2.9 to 1.8 ± 1.5 (p < 0.05) for back pain. The JOA score improved from 14.7 ± 8.2 to 23.7 ± 4.8 (p < 0.005). The average rate of improvement in the JOA score was 74.7% ± 34.7%. The ODI decreased from 46.1 ± 5.8 to 14.6 ± 7.0 (p < 0.005). The final clinical outcome was excellent in 47 patients (81.0%), good in 10 (17.3%), and fair in one (1.7%). No patient had a poor final outcome. There were few operative complications. Dural injury occurred during use of the endoscope in two patients. The facet joint was preserved in 83.5% ± 7.4% of cases on the approach side and in 94.5% ± 7.3% on the contralateral side.ConclusionsOSE is a single hole split‐type endoscopic technology. Compared with that for other minimally invasive spinal endoscopic techniques, the learning curve is less steep and easier to master. Open spinal endoscopy can achieve adequate decompression and lumbar discectomy with preservation of the facet joints and posterior ligamentous complex and can be performed widely.

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Section: Discussionmentioning

confidence: 99%

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Yu,

Zheng

2024

Medicine Advances

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“…The stiffness and phase results were consistent between the sine and triangle waveforms, suggesting that it may not be necessary to use both waveforms in future tests that adopt the standardized protocol. Sine waveforms are commonly used in spine testing to simplify test control, and approximate physiologic motion (Amin et al, 2015;Chamoli et al, 2015;Costi et al, 2008;Wilke et al, 2016), though triangle waves have also been adopted in position controlled tests to ensure a uniform test rate (Bennett and Kelly, 2013;Gardner-Morse and Stokes, 2004;Holsgrove et al, 2015a;Kotani et al, 2006). However, triangle waveforms may be less applicable in load control testing where the test rate will vary according to the stiffness of the specimen.…”

Section: Discussionmentioning

confidence: 99%

The equivalence of multi-axis spine systems: Recommended stiffness limits using a standardized testing protocol

Holsgrove

Amin

Ramos-Pascual

et al. 2018

Journal of Biomechanics

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The complexity of multi-axis spine testing often makes it challenging to compare results from different studies. The aim of this work was to develop and implement a standardized testing protocol across three six-axis spine systems, compare them, and provide stiffness and phase angle limits against which other test systems can be compared. Standardized synthetic lumbar specimens (n=5), comprising three springs embedded in polymer at each end, were tested on each system using pure moments in flexion-extension, lateral bending, and axial rotation. Tests were performed using sine and triangle waves with an amplitude of 8Nm, a frequency of 0.1Hz, and with axial preloads of 0 and 500N. The stiffness, phase angle, and R value of the moment against rotation in the principal axis were calculated at the center of each specimen. The tracking error was adopted asa measure of each test system to minimize non-principal loads, defined as the root mean squared difference between actual and target loads. All three test systems demonstrated similar stiffnesses, with small (<14%) but significant differences in 4 of 12 tests. More variability was observed in the phase angle between the principal axis moment and rotation, with significant differences in 10 of 12 tests. Stiffness and phase angle limits were calculated based on the 95% confidence intervals from all three systems. These recommendations can be used with the standard specimen and testing protocol by other research institutions to ensure equivalence of different spine systems, increasing the ability to compare in vitro spine studies.

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“…A crossbeam structure was mounted on a surface cap on the L1 superior endplate (Figure 3(a)). A force couple was applied to the extremities of the crossbeam to simulate flexion and extension bending with pure, unconstrained moments in a stepwise manner from 1 to 10 Nm, replicating an in vitro loading scenario 26 in accordance with published protocols. 5,22,27,28 A node on the anterior surface of the sacrum, below the sacral promontory, was constrained in all degrees of freedom and surrounded by a network of rigid links to prevent stress concentration (Figure 3(b)).…”

Section: Methodsmentioning

confidence: 99%

A biomechanical comparison of posterior fixation approaches in lumbar fusion using computed tomography based lumbosacral spine modelling

Ramakrishna

Chamoli

Larosa

et al. 2023

Proc Inst Mech Eng H

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Extreme lateral interbody fusion (XLIF) may be performed with a standalone interbody cage, or with the addition of unilateral or bilateral pedicle screws; however, decisions regarding supplemental fixation are predominantly based on clinical indicators. This study examines the impact of posterior supplemental fixation on facet micromotions, cage loads and load-patterns at adjacent levels in a L4-L5 XLIF at early and late fusion stages. CT data from an asymptomatic subject were segmented into anatomical regions and digitally stitched into a surface mesh of the lumbosacral spine (L1-S1). The interbody cage and posterior instrumentation (unilateral and bilateral) were inserted at L4-L5. The volumetric mesh was imported into finite element software for pre-processing, running nonlinear static solves and post-processing. Loads and micromotions at the index-level facets reduced commensurately with the extent of posterior fixation accompanying the XLIF, while load-pattern changes observed at adjacent facets may be anatomically dependent. In flexion at partial fusion, compressive stress on the cage reduced by 54% and 72% in unilateral and bilateral models respectively; in extension the reductions were 58% and 75% compared to standalone XLIF. A similar pattern was observed at full fusion. Unilateral fixation provided similar stability compared to bilateral, however there was a reduction in cage stress-risers with the bilateral instrumentation. No changes were found at adjacent discs. Posterior supplemental fixation alters biomechanics at the index and adjacent levels in a manner that warrants consideration alongside clinical information. Unilateral instrumentation is a more efficient option where the stability requirements and subsidence risk are not excessive.

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Global and segmental kinematic changes following sequential resection of posterior osteoligamentous structures in the lumbar spine: An in vitro biomechanical investigation using pure moment testing protocols

Cited by 9 publications

References 48 publications

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

The equivalence of multi-axis spine systems: Recommended stiffness limits using a standardized testing protocol

A biomechanical comparison of posterior fixation approaches in lumbar fusion using computed tomography based lumbosacral spine modelling

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