Biomechanical effect of graded minimal-invasive decompression procedures on lumbar spinal stability
Biomechanical effect of graded minimal-invasive decompression procedures on lumbar spinal stability
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DOI：
10.1007/s00402-012-1543-2
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发表时间：
2012-09-01
影响因子：
2.3
通讯作者：
Gercek, Erol
中科院分区：
文献类型：
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作者：
Hartmann, Frank;Janssen, Claudia;Gercek, Erol
减压手术是腰椎管狭窄症的标准手术治疗，但该手术通常与融合术相结合。微创减压手术是否足够，以及它们是否会损害脊柱的稳定性，目前仍在讨论中。为了分析不同的微创减压方法对减压节段及相邻节段在预负荷条件下运动范围的影响，在脊柱测试仪上测试了14具新鲜冰冻人腰椎(L2~L5)在预负荷和非预负荷条件下的屈伸、侧弯和旋转的屈伸、侧弯和旋转。减压节段L3/4及邻近节段L2/L3、L4/L5的活动度测量完整，在造成椎间韧带(ISL)切除、双侧下切开减压术、棘上韧带脱离(SSL)和双侧小关节内侧截骨术后，对所有节段的活动度均无显著影响。底切减压术显示前屈/后伸和侧弯时所有节段的活动度均显著增加。在内固定节段和相邻节段的屈曲/伸展过程中，SS1的脱离导致了ROM的显著增加。双侧内侧小关节切除后，除前屈/后伸外，所有运动方向的活动度均有下降，支持微创手术以保持脊柱的稳定性。因此，外科医生可以在不需要额外融合以保持脊柱稳定性的情况下，确定在个别患者身上可以执行哪种级别的减压程序。
Decompression surgery represents the standard operative treatment for lumbar spinal stenosis, but this procedure is often combined with fusion surgery. It is still discussed whether minimal-invasive decompression procedures are sufficient and if they compromise spinal stability as well. The aim of this study was to analyze the effects of different minimal-invasive decompression procedures on the range of motion (ROM) of the decompressed and adjacent segments under preload conditions.Fourteen fresh frozen human cadaver lumbar spines (L2-L5) were tested in a spinal testing device with a moment of 7.5 N m in flexion/extension, lateral bending and rotation with and without a preload. The ROM of the decompressed segment L3/4 and the adjacent segments L2/L3 and L4/L5 was measured intact and after creating a gradual defect with resection of the interspinous ligament (ISL), bilateral undercutting decompression, detachment of the supraspinous ligament (SSL) and bilateral medial facetectomy.The resection of the ISL had no significant effect on the ROM of all segments. Undercutting decompression showed a significant increase in the ROM of all segments during flexion/extension and lateral bending. The detachment of the SSL caused a significant increase of ROM during flexion/extension in the instrumented and adjacent segments. After bilateral medial facetectomy, a decrease of ROM was observed in all directions of motion except flexion/extension with preload.The results support minimal-invasive procedures for the preservation of spinal stability. Therefore, surgeons can determine which grade of decompression procedure can be performed in the individual patient without requiring additional fusion to maintain spinal stability.