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Circumferential dynamic stabilization of the lumbar spine: a biomechanical analysis

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Abstract

Purpose

To assess segmental angulation and mobility following implantation of the Charité artificial disc in combination with the posterior dynamic fixation device dynamic stabilization system (DSS) and the interspinous spacer Coflex at the L4–L5 segment, respectively.

Methods

Six human L4–L5 specimens were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation in a custom-made spine tester. The testing protocol was as follows: (a) intact condition, (b) destabilization by resection of the anterior longitudinal ligament (ALL), (c) implantation of the Charité with retained posterior longitudinal ligament (PLL), (d) supplemental DSS implantation, (e) removal of DSS rods and PLL resection, (f) DSS rod re-implantation, (g) enlargement of rod length, and (h) removal of DSS and implantation of Coflex. Range of motion (ROM), neutral zone, and segmental angulation were determined.

Results

ALL resection did not influence significantly ROM. TDR increased lateral bending and axial rotation only after resection of the PLL, whereas flexion/extension remained unchanged. DSS limited all degrees of freedom prior to and after PLL resection. Rod length enlargement had no significant effect. Coflex limited significantly flexion/extension compared to the intact state and TDR, whereas lateral bending and axial rotation remained unchanged. TDR increased lordosis, whereas Coflex had a substantial kyphosing effect.

Conclusions

This study demonstrates that posterior dynamic stabilization in combination with TDR reduces flexion/extension ROM and segmental lordosis in a monosegmental biomechanical model.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Ulm Medical School, Oberer Eselsberg 45, 89081, Ulm, Germany

    Wolfram Käfer, Balkan Cakir & Heiko Reichel

  2. Center of Musculo-Skeletal Research, Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany

    Stefan Midderhoff & Hans-Joachim Wilke

  3. Department of Spine Surgery, Westpfalz-Klinikum GmbH, Standort II, Im Flur 1, 66869, Kusel, Germany

    Wolfram Käfer

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  1. Wolfram Käfer
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  2. Balkan Cakir
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  3. Stefan Midderhoff
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  5. Hans-Joachim Wilke
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Correspondence to Wolfram Käfer.

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Käfer, W., Cakir, B., Midderhoff, S. et al. Circumferential dynamic stabilization of the lumbar spine: a biomechanical analysis. Eur Spine J 23, 2330–2339 (2014). https://doi.org/10.1007/s00586-014-3286-y

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  • DOI: https://doi.org/10.1007/s00586-014-3286-y

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