Kinematic and Mechanical Comparisons of Lumbar Hybrid Fixation Using Dynesys and Cosmic Systems

Chien, Chen Ying; Kuo, Yi Jie; Lin, Shu; Luh, Yuan Ping

doi:10.1097/brs.0000000000000388

Cited by 18 publications

(16 citation statements)

References 28 publications

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“…However, no signi cant between-group di erence was found in CASD, which indicated that topping-o technique was more e ective in preventing radiographical parameters. is may be explained by the decrease of compensatory mechanisms in the segmental range of motion in the topping-o group [34,43]. Our results showed that postoperative GLL was similar in the topping-o group and PLIF group.…”

Section: Discussionmentioning

confidence: 50%

Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

Wang

Sun

Zhang

et al. 2020

BioMed Research International

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The treatment effects of topping-off technique were still controversial. This study compared all available data on postoperative clinical and radiographic outcomes of topping-off technique and posterior lumbar interbody fusion (PLIF). PubMed, EMBASE, and Cochrane were systematically reviewed. Variations included radiographical adjacent segment disease (RASD), clinical adjacent segment disease (CASD), global lumbar lordosis (GLL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, and complication rates. Sixteen studies, including 1372 cases, were selected for the analysis. Rates of proximal RASD (P=0.0004), distal RASD (P=0.03), postoperative VAS-B (P=0.0001), postoperative VAS-L (P=0.02), EBL (P=0.007), and duration of surgery (P=0.02) were significantly lower in topping-off group than those in PLIF group. Postoperative ODI after 3 years (P=0.04) in the topping-off group was significantly less than that in the PLIF group. There was no significant difference in the rates of CASD (P=0.06), postoperative GLL (P=0.14), postoperative ODI within 3 years (P=0.24), and postoperative JOA (P=0.70) and in reoperation rates (P=0.32) and complication rates (P=0.27) between topping-off group and PLIF. The results confirmed that topping-off technique could effectively prevent ASDs after lumbar internal fixation. However, this effect is effective in preventing RASD. Topping-off technique is more effective in improving the subjective feelings of patients rather than objective motor functions compared with PLIF. With the development of surgical techniques, both topping-off technique and PLIF are safe.

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Section: Discussionmentioning

confidence: 50%

Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

Wang

Sun

Zhang

et al. 2020

BioMed Research International

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“…Ideal hybrid stabilization has to preserve normal ROM as much as possible, and the transition segment has to not be too rigid or movable to preserve both the transition and adjacent segments, because a rigid transition segment transfers excessive stress to the adjacent segments from the transition segment. 6,10 At the transition segment, both the IH and PH models suppress the kinematic compensation from the fusion segment and demonstrate smaller ROM and IDP than the fusion model in all loading directions. These values for the PH model were even lower than those for the intact model in all loading directions except under axial rotation, and the IH model showed smaller ROM and IDP than the intact model, especially under extension, because the ISD is designed to distract the foramen.…”

Section: Discussionmentioning

confidence: 98%

“…35 Other studies have concluded that PDS at the adjacent segment was not recommended in patients with clinically asymptomatic ASD. 6,34 A previous meta-analysis also addressed the issue that PDS has no competitive advantage for ASD prevention compared with fusion surgery. 21 However, clinical studies addressing IH demonstrated that IH achieved significantly lower ASD than conventional fusion surgery.…”

Section: Figmentioning

confidence: 99%

“…Moreover, IH has some advantages compared with PDS at the transition segment. 6,10 Installing pedicle screws at the transition segment during PH could cause facet joint damage and requires a long incision and paraspinal muscle dissection, which could be avoided in ISD placement. ISD installation usually takes less than 30 minutes, and minimal dissection of the posterior elements is required.…”

Section: Figmentioning

confidence: 99%

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Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw–based dynamic fixator

Lee

Kim

Lee

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEPedicle screw-rod–based hybrid stabilization (PH) and interspinous device–based hybrid stabilization (IH) have been proposed to prevent adjacent-segment degeneration (ASD) and their effectiveness has been reported. However, a comparative study based on sound biomechanical proof has not yet been reported. The aim of this study was to compare the biomechanical effects of IH and PH on the transition and adjacent segments.METHODSA validated finite element model of the normal lumbosacral spine was used. Based on the normal model, a rigid fusion model was immobilized at the L4–5 level by a rigid fixator. The DIAM or NFlex model was added on the L3–4 segment of the fusion model to construct the IH and PH models, respectively. The developed models simulated 4 different loading directions using the hybrid loading protocol.RESULTSCompared with the intact case, fusion on L4–5 produced 18.8%, 9.3%, 11.7%, and 13.7% increments in motion at L3–4 under flexion, extension, lateral bending, and axial rotation, respectively. Additional instrumentation at L3–4 (transition segment) in hybrid models reduced motion changes at this level. The IH model showed 8.4%, −33.9%, 6.9%, and 2.0% change in motion at the segment, whereas the PH model showed −30.4%, −26.7%, −23.0%, and 12.9%. At L2–3 (adjacent segment), the PH model showed 14.3%, 3.4%, 15.0%, and 0.8% of motion increment compared with the motion in the IH model. Both hybrid models showed decreased intradiscal pressure (IDP) at the transition segment compared with the fusion model, but the pressure at L2–3 (adjacent segment) increased in all loading directions except under extension.CONCLUSIONSBoth IH and PH models limited excessive motion and IDP at the transition segment compared with the fusion model. At the segment adjacent to the transition level, PH induced higher stress than IH model. Such differences may eventually influence the likelihood of ASD.

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“…The lumbosacral model from L1 to S1 segments has been developed and validated in the previous studies of the current authors (Chien et al, 2014;Chuang et al, 2012;Chuang et al, 2013). For a paired facet joint, the orientation and separation of the articulating surfaces were cautiously established to ensure a consistent unloaded neutral position within a range of around 0.5 mm.…”

Section: Lumbosacral Modelsmentioning

confidence: 99%

Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis

Hsieh

Chen

et al. 2017

Clinical Biomechanics

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Kinematic and Mechanical Comparisons of Lumbar Hybrid Fixation Using Dynesys and Cosmic Systems

Abstract: N/A.

Cited by 18 publications

References 28 publications

Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw–based dynamic fixator

Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis

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