Effects of Lumbar Arthrodesis on Adjacent Segments Differences Between Surgical Techniques
Effects of Lumbar Arthrodesis on Adjacent Segments Differences Between Surgical Techniques
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DOI：
10.1097/brs.0b013e31824da81d
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发表时间：
2012-08-01
期刊：
影响因子：
3
通讯作者：
Ha, Yoon
中科院分区：
文献类型：
--
作者：
Kim, Tae Yup;Kang, Kyoung Tak;Ha, Yoon
研究设计.有限元分析。评价不同手术技术在关节融合术对相邻节段影响方面的差异。后路刚性固定结合经椎弓根螺钉插入的增强是腰椎关节固定术中最常用的技术之一，显示出即时稳定和更高融合率的益处，但据报道与相邻节段的更大应力相关。然而，相邻节段的应力增加需要进一步评估，因为前路腰椎椎间融合术、后路腰椎椎间融合术和半刚性固定术对相邻节段的影响差异尚未确定。建立了人体腰椎的有限元模型。使用三个脊柱节段（L2-L5）进行研究。完整的脊柱模型进行了验证，通过比较它与以前报道的模型。然后对4种不同的融合模型进行分析和比较：（1）前路腰椎椎间融合模型;（2）后路腰椎椎间融合模型;（3）半刚性固定结合后路腰椎椎间融合模型;（4）刚性固定结合后路腰椎椎间融合模型。在这4种模型中，刚性固定模型显示出最大的应力，椎间盘压力和上下相邻节段小关节的接触力增加。半刚性内固定模型的应力水平第二高，前路椎间融合模型的应力水平最低。虽然骨融合已经完成，但腰椎关节融合术对相邻节段的影响可能因关节融合术所用的手术技术而异。半刚性固定结合关节融合术值得仔细考虑和进一步详细研究，因为它可能比刚性固定对相邻节段造成更小的应力，同时保持后一种手术的优点。
Study Design. A finite element analysis.Objective. To evaluate the differences between surgical techniques in terms of the effects of arthrodesis on adjacent segments.Summary of Background Data. Augmentation with posterior rigid fixation combined with transpedicular screw insertion, which is one of the most popular techniques for lumbar arthrodesis, shows benefits in immediate stabilization and a higher fusion rate but is reportedly correlated with greater stress on adjacent segments. However, the increased stress on adjacent segments needs further evaluation because the differences of the effects on adjacent segments between surgical techniques, including anterior lumbar interbody fusion, posterior lumbar interbody fusion, and semirigid fixation, have not yet been determined.Methods. A finite element model of the human lumbar spine was developed. Three spinal segments (L2-L5) were used to investigate. The intact spinal model was validated by comparing it with previously reported models. Then, 4 arthrodesis models were analyzed and compared: (1) anterior lumbar interbody fusion model; (2) posterior lumbar interbody fusion model; (3) semirigid fixation model combined with posterior lumbar interbody fusion; and (4) rigid fixation model combined with posterior lumbar interbody fusion.Results. Among these 4 models, the rigid fixation model showed the greatest amount of stress, with increased intervertebral disc pressure and contact force of the facet joints of both upper and lower adjacent segments. The second highest stress levels were seen in the semirigid fixation model and the lowest stress levels were seen in the anterior lumbar interbody fusion model.Conclusion. Although bony fusion had been completed, the effects of lumbar arthrodesis on adjacent segments could vary according to the surgical technique used for arthrodesis. Semirigid fixation combined with arthrodesis deserves careful consideration and further detailed study because it may cause less stress on adjacent segments than rigid fixation while maintaining the benefits of the latter procedure.