Biomechanical study on the effect of five different lumbar reconstruction techniques on adjacent-level intradiscal pressure and lamina strain
Biomechanical study on the effect of five different lumbar reconstruction techniques on adjacent-level intradiscal pressure and lamina strain
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DOI：
10.3171/spi.2006.5.2.150
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发表时间：
2006-08-01
影响因子：
2.8
通讯作者：
Minami, Akio
中科院分区：
文献类型：
--
作者：
Sudo, Hideki;Oda, Itaru;Minami, Akio
Object.本研究的目的是比较五种腰椎重建模型对相邻节段的生物力学影响，并分析三个因素的影响：结构刚度、矢状面对准和融合节段的数量。通过对10个小腿脊柱（L3-S1）标本施加纯力矩进行非破坏性屈伸测试。模拟单节段（L5-6）或两节段（L5-S1）后路融合方法：1）单节段后外侧融合（PLF）; 2）单节段PLF与椎间融合器（单节段PLIF/PLF）; 3）两节段PLF; 4）两节段PLIF/PLF; 5）后凸中的两节段PLF（两节段后凸PLF）。分析重建节段的活动度（ROM）、椎间盘内压力（IDP）和上（L4-5）相邻节段的椎板应变，与单节段和两节段融合后的PLF模型相比，PLIF/PLF模型的ROM显著降低。如果融合节段的数量增加，则PLIF/PLF手术的样本中的压力和应变也会增加，比单独PLF手术的压力和应变增加更多。在单节段PLIF/PLF模型中，作者观察到与后凸两节段PLF模型相比，IDP和椎板应变降低，尽管后者的初始刚度水平较高。如果通过PLIF矫正局部后凸畸形可以减少融合节段的数量，那么这种手术对于减少相邻节段的退行性改变可能是有价值的。
Object. The objectives of this study were to compare the biomechanical effects of five lumbar reconstruction models on the adjacent segment and to analyze the effects of three factors: construct stiffness, sagittal alignment, and the number of fused segments.Methods. Nondestructive flexion-extension tests were performed by applying pure moments to 10 calf spinal (L3-S1) specimens. One-segment (L5-6) or two-segment (L5-S1) posterior fusion methods were simulated: 1) one-segment posterolateral fusion (PLF); 2) one-segment PLF with interbody fusion cages (one-segment PLIF/PLF); 3) two-segment PLF; 4) two-segment PLIF/PLF; and 5) two-segment PLF in kyphosis (two-segment kyphotic PLF). The range of motion (ROM) of the reconstructed segments, intradiscal pressure (IDP), and lamina strain in the upper (L4-5) adjacent segment were analyzed.The ROM was significantly decreased in the PLIF/PLF models compared with that in the PLF alone models after both the one- and two-segment fusions. If the number of fused segments was increased, the pressure and strains were also increased in specimens subjected to the PLIF/PLF procedure, more so than the PLF-alone procedure. In the one-segment PLIF/PLF model the authors observed a reduced IDP and lamina strain compared with those in the kyphotic two-segment PLF model despite the latter's higher levels of initial stiffness.Conclusions. If the number of fused levels can be reduced by using PLIF to correct local kyphosis, then this procedure may be valuable for reducing adjacent-segment degenerative changes.