The Resistance to Flexion of the Lumbar Intervertebral Joint

Adams, Michael A.; Hutton, W. C.; Stott, J. R. R.

doi:10.1097/00007632-198005000-00007

Cited by 339 publications

(134 citation statements)

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“…1,2,8,21 Adams et al 2 investigated the contributions of the posterior ligaments to the resistance of the segment in flexion by using a stiffness protocol. They stated that the CL provided more resistance to flexion compared with the ISL/SSL, which is in agreement with the current findings.…”

Section: Quantitative Analysismentioning

confidence: 99%

“…2,12,15,24,28,30 By sequentially cutting the ligaments, researchers have analyzed the changes in the range of motion of the spinal segments to assess the role of each ligament in spine kinematics. The changes in the segmental stiffness and range of motion of the spine specimens have been documented in biomechanical evaluations in which either traditional flexibility testing, 15,24,28,30 hybrid testing protocols, 2 or robotic applications were used.…”

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confidence: 99%

“…ness, 2,12,15,24,28,30 there is no information on the change in the quality of the motion as assessed and defined by the ICR, which is a point on the axis of rotation found at a planar section of the motion segment. Understanding the quality of spinal motion as well as the quantity can assist in the diagnosis of ligamentous injury and the determination of the optimal treatment strategy.…”

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confidence: 99%

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Instantaneous center of rotation behavior of the lumbar spine with ligament failure

Alapan

Demir

Kaner

et al. 2013

SPI

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Object The goal of this study was to investigate the effect of ligament failure on the instantaneous center of rotation (ICR) in the lower lumbar spine. Methods A 3D finite element model of the L4–5 segment was obtained and validated. Ligament failure was simulated by reducing ligaments in a stepwise manner from posterior to anterior. A pure bending moment of 7.5 Nm was applied to the model in 3 anatomical planes for the purpose of validation, and a 6-Nm moment was applied to analyze the effect of ligament failure. For each loading case, ligament reduction step, and load increment, the range of motion of the segment and the ICR of the mobile (L-4) vertebra were calculated and characterized. Results The present model showed a consistent increase in the range of motion as the ligaments were removed, which was in agreement with the literature reporting the kinematics of the L4–5 segment. The shift in the location of the ICR was below 5 mm in the sagittal plane and 3 mm in both the axial and coronal planes. Conclusions The location of the ICR changed in all planes of motion with the simulation of multiple ligament injury. The removal of the ligaments also changed the load sharing within the motion segment. The change in the center of rotation of the spine together with the change in the range of motion could have a diagnostic value, revealing more detailed information on the type of injury, the state of the ligaments, and load transfer and sharing characteristics of the segment.

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Section: Quantitative Analysismentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Instantaneous center of rotation behavior of the lumbar spine with ligament failure

Alapan

Demir

Kaner

et al. 2013

SPI

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“…Furthermore, the relevance of preservation of the posterior midline structures is still unclear. As most translational and rotational spinal stability is provided by the vertebral disc and the zygapophyseal joints [15,16], and the momentum generated by the posterior ligaments during flexion is small compared with the force exerted by back muscles [17], spinal stability is possibly minimally affected by a conventional laminectomy performed with resection of the posterior midline structures.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

et al. 2015

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. Conclusion The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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“…In an experimental study on the limit of flexion in lumbar motion segment, Adams et al [2] noted an increase in strain of 33% in the supra/interspinous ligament at first sign of injury. In another experimental study, Dumas et al [7] stated that the elongation of the inter/supraspinous ligament complex did not exceed 7.4 mm until the first sign of injury occurred.…”

Section: Discussionmentioning

confidence: 99%

Determination of inter-spinous process distance in the lumbar spine

Neumann

Wang

Kärrholm

et al. 1999

European Spine Journal

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IntroductionA key factor in the evaluation of lumbar spine trauma is the position of the spinous processes in relation to each other as an indication of the status of the posterior stabilising structures. More or less severe separation of the spinous processes can result in a loss of mechanical support from the posterior spinal structures, and consequently in potential instability of the injured spinal segment. The exact amount of separation of the posterior elements that indicates such an injury on conventional radiographs is, however, not known. The increase in interspinal process distance at the location of an injury of a lumbar spinal segment should be compared with the "normal" interspinal process distance at adjacent levels in the lumbar Abstract Fracture of a spinal segment with minimal or no compression of the vertebral body can be highly unstable. Screening for such an injury in the lumbar spine is often obstructed in a multi-injured patient, because of difficulty in obtaining adequate sagittal radiographs. The position of the spinous processes in relation to each other is the key for proper evaluation of the status of the posterior stabilising structures. The amount of separation or axial rotation of the posterior part of the vertebra that can occur before failure of the posterior structures has not been unambiguously defined. Despite this, it can be assumed that severe separation of the spinous processes indicates a more or less pronounced loss of mechanical support. An analysis of how the posterior spinous processes relate to each other on an anteroposterior (AP) radiograph could obviate this problem. A new, simple and reproducible radiographic tool is presented for screening of an eventual rupture of posterior structures of the lumbar spine. This method is based on measurements of the variation in interspinal process distance between adjacent levels in lumbar spine in a normal population. Two hundred normal AP radiographs of non-injured thoracolumbar spine were studied. The interspinal process distance was measured as the distance between the cranial ends of the adjacent projections of spinous processes on AP radiographs. The mean values and 99% confidence limits for changes in the interspinal process distances between adjacent spinal levels were determined and analysed in relation to age, gender and spinal segment level. An upper limit of a normal difference in distance between the spinous processes at two adjacent levels was determined to be 7-10 mm, depending on age and location in the lumbar spine. A difference in interspinal process distance exceeding 7 mm between two adjacent lumbar levels should alert a surgeon to severe and unstable injury.

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The Resistance to Flexion of the Lumbar Intervertebral Joint

Cited by 339 publications

References 0 publications

Instantaneous center of rotation behavior of the lumbar spine with ligament failure

Instantaneous center of rotation behavior of the lumbar spine with ligament failure

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Determination of inter-spinous process distance in the lumbar spine

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