Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis
Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis
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DOI：
10.1186/s13018-020-01812-5
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发表时间：
2020-07-29
影响因子：
2.6
通讯作者：
Lu, Yi
中科院分区：
文献类型：
--
作者：
Lu, Teng;Lu, Yi
背景椎板间稳定和棘突间稳定是两种较新的微创腰椎稳定方法，常与腰椎减压术联合应用治疗腰椎管狭窄症。这两种方法有某些相似之处，因此经常被归类在一起。然而，这两种方法提供了不同的生物力学特性，这影响其各自的有效性和手术successful. Objective. ObjectiveComparison椎板间稳定后腰椎减压（ILS）和棘突间稳定后腰椎减压（ISS）的生物力学特性。为了进行比较，在生物力学分析中还包括单纯腰椎减压术（DA）和减压加内固定融合术（DF）。DA、DF、ISS和ILS。为了尽可能减少器械的影响并关注不同方法的生物力学特性，将EQUIPLEX器械作为模型系统放置在不同的位置，以比较ISS和ILS。比较四种手术结构在手术节段和相邻节段的活动度（ROM）和椎间盘应力峰值。应力峰值的棘突，整个装置，装置翼之间进行了比较ISS和ILS.ResultsCompared相比，DA，ROM和椎间盘应力在手术水平ILS或ISS是在扩展低得多。在手术节段，ILS的ROM和椎间盘应力分别为1.27度和0.36MPa，ISS分别为1.51度和0.55MPa。这与DA. ILS中的4.71度和1.44MPa相比，（分别为2.06-4.85度和0.37-0.98MPa）或ISS（分别为2.07-4.78度和0.37-0.98MPa），与DF相比，相邻节段的ROM和椎间盘应力也显著降低（分别为2.50-7.20度和0.37-1.20MPa）。与ISS相比，ILS进一步降低了手术节段的ROM和椎间盘应力，分别降低了8%和25%。ILS组棘突应力峰值为13.93 ~ 101 MPa，ISS组为31.08-172.5MPa，差异有显著性（P <0.05）。在旋转，ILS产生了一个更低的应力峰值在仪表翼比ISS（128.7MPa与222.1MPa）。ConclusionILS和ISS部分解决的问题，节段性不稳定的DA和超机动性和过载在相邻的水平DF。与ISS相比，ILS实现了更大的节段稳定性，并导致更低的椎间盘应力。此外，ILS降低了棘突骨折和器械失效的风险。
BackgroundInterlaminar stabilization and interspinous stabilization are two newer minimally invasive methods for lumbar spine stabilization, used frequently in conjunction with lumbar decompression to treat lumbar stenosis. The two methods share certain similarities, therefore, frequently being categorized together. However, the two methods offer distinct biomechanical properties, which affect their respective effectiveness and surgical success.ObjectiveTo compare the biomechanical characteristics of interlaminar stabilization after lumbar decompression (ILS) and interspinous stabilization after lumbar decompression (ISS). For comparison, lumbar decompression alone (DA) and decompression with instrumented fusion (DF) were also included in the biomechanical analysis.MethodsFour finite element models were constructed, i.e., DA, DF, ISS, and ILS. To minimize device influence and focus on the biomechanical properties of different methods, Coflex device as a model system was placed at different position for the comparison of ISS and ILS. The range of motion (ROM) and disc stress peak at the surgical and adjacent levels were compared among the four surgical constructs. The stress peak of the spinous process, whole device, and device wing was compared between ISS and ILS.ResultsCompared with DA, the ROM and disc stress at the surgical level in ILS or ISS were much lower in extension. The ROM and disc stress at the surgical level in ILS were 1.27 degrees and 0.36MPa, respectively, and in ISS 1.51 degrees and 0.55MPa, respectively in extension. This is compared with 4.71 degrees and 1.44MPa, respectively in DA. ILS (2.06-4.85 degrees and 0.37-0.98MPa, respectively) or ISS (2.07-4.78 degrees and 0.37-0.98MPa, respectively) also induced much lower ROM and disc stress at the adjacent levels compared with DF (2.50-7.20 degrees and 0.37-1.20MPa, respectively). ILS further reduced the ROM and disc stress at the surgical level by 8% and 25%, respectively, compared to ISS. The stress peak of the spinous process in ILS was significantly lower than that in ISS (13.93-101MPa vs. 31.08-172.5MPa). In rotation, ILS yielded a much lower stress peak in the instrumentation wing than ISS (128.7MPa vs. 222.1MPa).ConclusionILS and ISS partly address the issues of segmental instability in DA and hypermobility and overload at the adjacent levels in DF. ILS achieves greater segmental stability and results in a lower disc stress, compared to ISS. In addition, ILS reduces the risk of spinous process fracture and device failure.