Torsion biomechanics of the spine following lumbar laminectomy: a human cadaver study

Bisschop, Arno; Dieën, Jaap H. van; Kingma, Idsart; Veen, Albert J. van der; Jiya, Timothy U.; Mullender, Margriet G.; Paul, Cornelis P. L.; Kleuver, Marinus de; Royen, Barend J. van

doi:10.1007/s00586-013-2699-3

Cited by 21 publications

(28 citation statements)

References 22 publications

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“…All articulating parts were kept free. The casting-mould was placed in a hydraulic materials testing machine (InstronÓ, model 8872, Norwood, Canada) [3]. The caudal vertebral body was fixed on a plateau that allowed movement in axial and transverse directions only.…”

Section: Parametersmentioning

confidence: 99%

“…Since compression was applied in a purely axial direction, bending moments were minimized. Subsequently, while maintaining the axial load, torsion load was applied with a constant rate of 3.0°per min through a cable, which was securely fixed to the part of the casting-mould that contained the caudal vertebral body [3]. The test was stopped after hearing a crack or after a large moment reduction was seen.…”

Section: Parametersmentioning

confidence: 99%

“…TMF was defined as the point at which maximum load was recorded in the load-displacement curves for each specimen. These data were presented previously [3]. Early torsion stiffness (ETS) and late torsion stiffness (LTS) were calculated from the load-displacement curve, between, respectively, 20-40 and 60-80 % of the TMF.…”

Section: Parametersmentioning

confidence: 99%

“…Shear biomechanical properties after laminectomy could be predicted from imaging data, which may support such decision-making [4]. However, in daily practice the spine is also loaded in torsion [3]. Torsion loads may cause and progress disc degeneration and may even cause failure of a segment [1,7,8,10].…”

Section: Introductionmentioning

confidence: 99%

“…Torsion loads may cause and progress disc degeneration and may even cause failure of a segment [1,7,8,10]. Previously, it has been shown in an in vitro experiment that laminectomy results in a substantial decrease of torsion stiffness and torsion moment to failure (TMF) of lumbar spinal segments [3]. For shear loads, the biomechanical behaviour of a spinal motion segment following laminectomy has been shown to depend on disc degeneration, facet joint degeneration, Modic changes, Schmorl's nodes, intervertebral disc and pedicle geometry, and facet joint angles [4].…”

Section: Introductionmentioning

confidence: 99%

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Which factors prognosticate rotational instability following lumbar laminectomy?

Bisschop

Kingma²,

Bleys³

et al. 2013

Eur Spine J

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Purpose Reduced strength and stiffness of lumbar spinal motion segments following laminectomy may lead to instability. Factors that predict shear biomechanical properties of the lumbar spine were previously published. The purpose of the present study was to predict spinal torsion biomechanical properties with and without laminectomy from a total of 21 imaging parameters. Method Radiographs and MRI of ten human cadaveric lumbar spines (mean age 75.5, range 59-88 years) were obtained to quantify geometry and degeneration of the motion segments. Additionally, dual X-ray absorptiometry (DXA) scans were performed to measure bone mineral content and density. Facet-sparing lumbar laminectomy was performed either on L2 or L4. Spinal motion segments were dissected (L2-L3 and L4-L5) and tested in torsion, under 1,600 N axial compression. Torsion moment to failure (TMF), early torsion stiffness (ETS, at 20-40 % TMF) and late torsion stiffness (LTS, at 60-80 % TMF) were determined and bivariate correlations with all parameters were established. For dichotomized parameters, independent-sample t tests were used. Results Univariate analyses showed that a range of geometric characteristics and disc and bone quality parameters were associated with torsion biomechanical properties of lumbar segments. Multivariate models showed that ETS, LTS and TMF could be predicted for segments without laminectomy (r 2 values 0.693, 0.610 and 0.452, respectively) and with laminectomy (r 2 values 0.952, 0.871 and 0.932, respectively), with DXA-derived measures of bone quality and quantity as the main predictors. Conclusions Vertebral bone content and geometry, i.e. intervertebral disc width, frontal area and facet joint tropism, were found to be strong predictors of ETS, LTS and TMF following laminectomy, suggesting that these variables could predict the possible development of postoperative rotational instability following lumbar laminectomy. Proposed diagnostic parameters might aid surgical decision-making when deciding upon the use of instrumentation techniques.

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Section: Parametersmentioning

confidence: 99%

Section: Parametersmentioning

confidence: 99%

Section: Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Which factors prognosticate rotational instability following lumbar laminectomy?

Bisschop

Kingma²,

Bleys³

et al. 2013

Eur Spine J

Self Cite

View full text Add to dashboard Cite

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Effects of motion segment level, Pfirrmann intervertebral disc degeneration grade and gender on lumbar spine kinematics

Muriuki

Havey

Voronov

et al. 2016

Journal Orthopaedic Research

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MRI allows non-invasive assessment of intervertebral disc degeneration with the added clinical benefit of using nonionizing radiation. What has remained unclear is the relationship between assessed disc degeneration and lumbar spine kinematics. Kinematic outcomes of 54 multi-segment (L1-Sacrum) lumbar spine specimens were calculated to discover if such an underlying relationship exists with degeneration assessed using the Pfirrmann grading system. Further analyses were also conducted to determine if kinematic outcomes were affected by motion segment level, gender or applied compressive preload. Range of motion, hysteresis, high flexibility zone size and rotational stiffness in flexion-extension, lateral bending and axial rotation were the kinematic outcomes. Caudal intervertebral discs in our study sample were more degenerative than cranial discs. L5-S1 discs had the largest flexionextension range of motion (p < 0.005) and L1-L2 discs the lowest flexion high flexibility zone size (p < 0.013). No other strict cranialcaudal differences in kinematic outcomes were found. Low flexibility zone rotational stiffness increased with disc degeneration grade in extension, lateral bending and axial rotation (p < 0.001). Trends towards higher hysteresis and lower range of motion with increased degeneration were observed in flexion-extension and lateral bending. Applied compressive preload increased flexion-extension hysteresis and augmented the effect of degeneration on hysteresis (p < 0.0005). Female specimens had about one degree larger range of motion in all rotational modes, and higher flexion extension hysteresis (p ¼ 0.016). These results suggest that gender differences exist in lumbar spine kinematics. Additionally high disc loads, applied compressive preload or applied moment, are needed to kinematically distinguish discs with different levels of degeneration. Keywords: range of motion; high and low flexibility zone; rotational stiffness; hysteresis; MRI Pfirrmann magnetic resonance imaging (MRI) classification of intervertebral disc degeneration provides a measure of disc health based on the appearance of intervertebral spaces on T2-weighted MRI using intervertebral disc signal intensity, disc height, and the ability to distinguish between the annulus and nucleus of intervertebral discs. 1 Characteristics of intervertebral disc degeneration have been described as a reduction of water content in the nucleus pulposus causing a consolidation of the nucleus and a fibrotic appearance, development of focal defects in the disc, loss of disc height, and an increase in thickness and spacing of collagen fibers within the disc. 2-6 These morphological changes are thought to have an effect on biomechanical behavior of the disc. However, the relationship between MRI based disc grade criteria and lumbar spine biomechanics is unclear.Reductions in T2-weighted MR signal intensity are related to water loss in the intervertebral disc, changes in disc structure and the level of intervertebral disc degeneration. 4,7,8 Addition...

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Spine biomechanical testing methodologies: The controversy of consensus vs scientific evidence

2021

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Biomechanical testing methodologies for the spine have developed over the past 50 years. During that time, there have been several paradigm shifts with respect to techniques. These techniques evolved by incorporating state-of-the-art engineering principles, in vivo measurements, anatomical structure-function relationships, and the scientific method. Multiple parametric studies have focused on the effects that the experimental technique has on outcomes. As a result, testing methodologies have evolved, but there are no standard testing protocols, which makes the comparison of findings between experiments difficult and conclusions about in vivo performance challenging. In 2019, the international spine research community was surveyed to determine the consensus on spine biomechanical testing and if the consensus opinion was consistent with the scientific evidence. More than 80 responses to the survey were received. The findings of this survey confirmed that while some methods have been commonly adopted, not all are consistent with the scientific evidence. This review summarizes the scientific literature, the current consensus, and the authors' recommendations on best practices based on the compendium of available evidence.

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Torsion biomechanics of the spine following lumbar laminectomy: a human cadaver study

Cited by 21 publications

References 22 publications

Which factors prognosticate rotational instability following lumbar laminectomy?

Which factors prognosticate rotational instability following lumbar laminectomy?

Effects of motion segment level, Pfirrmann intervertebral disc degeneration grade and gender on lumbar spine kinematics

Spine biomechanical testing methodologies: The controversy of consensus vs scientific evidence

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