Lumbar Intradiscal Pressure after Posterolateral Fusion and Pedicle Screw Fixation.

Abstract

In vitro biomechanical testing was performed in single-functional spinal units of fresh calf lumbar spines, using pressure needle transducers to investigate the effect of posterolateral fusion (PLF) and pedicle screw constructs (PS) on intradiscal pressure (IDP), in order to elucidate the mechanical factors concerned with residual low back pain after PLF. IDP of 6 calf lumbar spines consisting of L4 and L5 vertebrae and an intervening disc was measured under axial compression, flexion-extension and lateral bending in the intact spine, PS, PLF and the destabilized spine. Relative to the intact spines, the destabilized spines showed increased IDP in all of lordings and moments. IDP under PS and PLF were significantly decreased in axial compression, extension and lateral bending loads (p<0.05). In flexion, IDP under PS and PLF increased linearly proportional to the magnitude of flexion moment and reached as high as IDP of the intact spines. These results demonstrated that despite an increase in the stiffness of motion segments after PLF and PS, significant high disc pressure is still generated in flexion. Flexibility of PS and PLF may cause increased axial load sharing of the disc in flexion and increased IDP. This high IDP may explain patients' persisting pain following PS and PLF.

Influence of a dynamic stabilisation system on load bearing of a bridged disc: an in vitro study of intradiscal pressure

“…Some in vitro studies extended the pressure measurement of the nucleus to the annulus to obtain a stress profilometry of the disc [3,16,23]. Since then a number of studies have investigated the effect of spinal instrumentation on the IDP of bridged and adjacent discs with varying and sometime controversial results [1,4,5,18,25,32,35].…”

Implantable MEMS compressive stress sensors: Design, fabrication and calibration with application to the disc annulus

“…In the spine, pressure sensors have been described for insertion into the disc nucleus in vivo (Buttermann et al, 2009;Guering et al, 2006;Nachemson and Morris, 1964;Nachemson and Elfstrom, 1970;Nachemson, 1981;Polga et al, 2004;Sato et al, 1999;Schultz et al, 1982;Wilke et al, 1999) and in vitro (Abe et al, 1998;Buttermann and Beaubien, 2008;Cripton et al, 2001;Cunningham et al, 1997;Dennison et al, 2008;Edwards et al, 2001;Moore et al, 2009;Nesson et al, 2008;Weinhoffer et al, 1995). In vivo spine measurements also include strain gauges on vertebral bone (Lanyon, 1972;Szivek et al, 2002;Szivek et al, 2005), and load cells inserted between vertebrae (Hauerstock et al, 2001;Ledet et al, 2000).…”