The Effects of an Interspinous Implant on the Kinematics of the Instrumented and Adjacent Levels in the Lumbar Spine

Lindsey, Derek P.; Swanson, Kyle E.; Fuchs, Paul D.; Hsu, Ken Y.; Zucherman, James; Yerby, Scott A.

doi:10.1097/01.brs.0000084877.88192.8e

Cited by 216 publications

(131 citation statements)

References 27 publications

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“…We could show that the pressure decreased in extension with all implants. This is also in agreement with a study by Swanson et al [11] using the X-Stop, who measured the intradiscal pressure at the instrumented and the adjacent levels with the same study design as Lindsey et al [7]. They could show, that there was a strong decrease of the IDP in the instrumented segment during extension without significant effect at the adjacent levels.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, it could be shown that this load is almost physiological if the anterior column of the spine is intact [7]. During loading the specimens were allowed to move unconstrained in the five uncontrolled degrees of freedom.…”

Section: Discussionmentioning

confidence: 99%

“…This emphasizes the need to use specific forceps meanwhile supplied by the distributers of Only a few reports of in vitro flexibility tests of interspinous implants are available in the literature for comparison. Most data about the biomechanical behavior of interspinous implants were gathered using the X-Stop [7,11,17]. Lindsey et al [7] could show for example, that the ROM in flexion-extension was significantly reduced at the instrumented level, whereas there was no significant effect for the other directions.…”

Section: Discussionmentioning

confidence: 99%

“…Most data about the biomechanical behavior of interspinous implants were gathered using the X-Stop [7,11,17]. Lindsey et al [7] could show for example, that the ROM in flexion-extension was significantly reduced at the instrumented level, whereas there was no significant effect for the other directions. Compared with our observations Lindsey et al could show that the sagittal angle was affected by implantation, the specimens were in a more flexed, i.e.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

et al. 2008

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Interspinous implants are used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous devices are to unload the facet joints, restore foraminal height and provide stability especially in extension but still allow motion. The aim of this in vitro study was to compare four different interspinous implants--Colfex, Wallis, Diam and X-Stop--in terms of their three-dimensional flexibility and the intradiscal pressure. Twenty-four human lumbar spine specimens were divided into four equal groups and tested with pure moments in flexion/extension, lateral bending and axial rotation: (1) intact, (2) defect, (3) after implantation. Range of motion and the intradiscal pressure were determined.In each implant-group the defect caused an increase in range of motion by about 8% in lateral bending to 18% in axial rotation. Implantation had similar effects with all four implants. In extension, Coflex, Wallis, Diam, and X-Stop all overcompensated the instability caused by the defect and allowed about 50% of the range of motion of the intact state. In contrast, in flexion, lateral bending and axial rotation the values of the range of motion stayed about the values of the defect state. Similarly the intradiscal pressure after implantation was similar to that of the intact specimens in flexion, lateral bending and axial rotation but much smaller during extension. All tested interspinous implants had a similar effect on the flexibility: they strongly stabilized and reduced the intradiscal pressure in extension, but had almost no effect in flexion, lateral bending and axial rotation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

et al. 2008

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“…Most of the previous relative studies have correlated ''static'' radiographic criteria (DH, traction spurs, osteophytes, etc) with clinical symptoms [3,37,45]. Others have additionally used advanced imaging techniques as computed tomography (CT), magnetic resonance imaging (MRI) [13,25,53,63].…”

Section: Discussionmentioning

confidence: 99%

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related reoperation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentationmatched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade \II, while the exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration[UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2-4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65? 13 and 64? 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6 months. The instrumented levels averaged 2.5 ? 1 vertebra for both groups. All 45 spines showed radiological fusion 8-12 months postoperatively. Lumbar lordosis did not change postoperatively. Postoperatively at the first cephalad adjacent segment: DH increased in the group W (P = 0.042); ROM significantly increased only in group C (ANOVA, P \ 0.02); olisthesis decreased both in flexion (P = 0.0024) and extension (P = 0.012) in group W. The degeneration or deterioration of already existed ASD in the two cephalad segments was shown in 1 (4.1%) and 6 (28.6%) spines in W and C groups, respectively. Physical function (SF-36) and ODI improved postoperatively (P \ 0.001), but in favour of the patients of group W (P \ 0.05) at the final evaluation. Symptomatic ASD required surgical intervention was in 3 (14%) patients of group C and none in group W. ASD remains a significant problem and accounts for a big portion of revision surgery following instrumented lumbar fusion. In this series, the Wallis interspinous implant changed the natural history of ASD and saved th...

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Interspinous Devices: State of the Art

Giannetti

Bartalesi

Tenucci

et al. 2013

Minimally Invasive Surgery of the Lumbar Spine

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The Effects of an Interspinous Implant on the Kinematics of the Instrumented and Adjacent Levels in the Lumbar Spine

Abstract: The implant does not significantly alter the kinematics of the motion segments adjacent to the instrumented level.

Cited by 216 publications

References 27 publications

Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Interspinous Devices: State of the Art

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