Abstract
Introduction
Posterior lumbar interbody fusion (PLIF) and internal fixation are commonly performed for the treatment of lower back pain due to lumbar spinal degeneration. We have developed a novel interspinous fixation device, the interspinous fastener (ISF) for potential use in the surgical management of degenerative spinal disease. The aim of this study was to assess the in vitro biomechanical characteristics of calf lumbar spine specimens after ISF fixation with modified PLIF.
Materials and methods
Ten lumbar spine (L3–L6) specimens from ten fresh calf cadavers (8–10 weeks of age) were used. Each specimen underwent sequential testing for each of the following four groups: no instrumentation (INTACT); interspinous fusion device fixation + PLIF (ISF); unilateral pedicle screw and titanium rod fixation + PLIF (UPS); bilateral pedicle screw and titanium rod fixation + PLIF (BPS). Outcome measures included angular range of motion (ROM) during unloaded and loaded (8 Nm) flexion, extension, left bending, right bending, left torsion and right torsion.
Results
For all unloaded and loaded assessments, ROM was significantly higher in the INTACT group compared with all other groups (P < 0.05). Similarly, ROM was significantly higher in the UPS group (indicating decreased stability) compared with the ISF and BPS groups (P < 0.05). The only significant difference between the ISF and BPS groups was in the ROM with unloaded extension (higher in the BPS group, P = 0.006).
Conclusions
We found that ISF fixation with PLIF of the lower lumbar spine provided biomechanical stability that was equivalent to that associated with bilateral pedicle screw/rod fixation with PLIF. The ISF shows potential as an alternative means of fixation in the surgical management of degenerative spinal disease.
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References
Szpalski M, Gunzburg R (2003) Lumbar spinal stenosis in the elderly: an overview. Eur Spine J 12(Suppl 2):S170–S175
Freemont AJ (2009) The cellular pathobiology of the degenerate intervertebral disc and discogenic back pain. Rheumatology (Oxford) 48:5–10
Hughes SP, Freemont AJ, Hukins DW, McGregor AH, Roberts S (2012) The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. J Bone Joint Surg Br 94:1298–1304
Salzberg L (2012) The physiology of low back pain. Prim Care 39:487–498
Spoor AB, Oner FC (2013) Minimally invasive spine surgery in chronic low back pain patients. J Neurosurg Sci 57:203–218
Atlas SJ, Nardin RA (2003) Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle Nerve 27:265–284
Mummaneni PV, Haid RW, Rodts GE (2004) Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:24–30
Yu AK, Siegfried CM, Chew B, Hobbs J, Sabersky A, Jho DJ, Cook DJ, Bellotte JB, Whiting DM, Cheng BC (2012) Biomechanics of posterior dynamic fusion systems in the lumbar spine: implications for stabilization with improved arthrodesis. J Spinal Disord Tech
Esses SI, Sachs BL, Dreyzin V (1993) Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine (Phila Pa 1976) 18:2231–2238 (discussion 8–9)
Fidler MW (1997) Spinal fusion: a combined anterior and supplementary interspinous technique. Eur Spine J 6:214–218
Wang JC, Haid RW Jr, Miller JS, Robinson JC (2006) Comparison of CD HORIZON SPIRE spinous process plate stabilization and pedicle screw fixation after anterior lumbar interbody fusion. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine 4:132–136
Gillespie KA, Dickey JP (2004) Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model. Spine (Phila Pa 1976) 29:1208–1216
Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Xiang M, Zhao WD, Zhong SZ (2009) C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine 34:371–377
Zhang J, He X, Li H, Wang D, Zhao W, Xu J, Lan B, Xu S (2006) Biomechanical study of anterior cervical corpectomy and step-cut grafting with bioabsorbable screws fixation in cadaveric cervical spine model. Spine (Phila Pa 1976) 31:2195–2201
Pradhan BB, Turner AW, Zatushevsky MA, Cornwall GB, Rajaee SS, Bae HW (2012) Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis. Laboratory investigation. J Neurosurg Spine 16:585–593
Kettler A, Drumm J, Heuer F, Haeussler K, Mack C, Claes L, Wilke HJ (2008) Can a modified interspinous spacer prevent instability in axial rotation and lateral bending? A biomechanical in vitro study resulting in a new idea. Clin Biomech (Bristol, Avon) 23:242–247
Cripton PA, Bruehlmann SB, Orr TE, Oxland TR, Nolte LP (2000) In vitro axial preload application during spine flexibility testing: towards reduced apparatus-related artefacts. J Biomech 33:1559–1568
Fan J, Yu GR, Liu F, Zhao J, Zhao WD (2010) A biomechanical study on the direct repair of spondylolysis by different techniques of fixation. Orthop Surg 2:46–51
Karahalios DG, Kaibara T, Porter RW, Kakarla UK, Reyes PM, Baaj AA, Yaqoobi AS, Crawford NR (2010) Biomechanics of a lumbar interspinous anchor with anterior lumbar interbody fusion. Neurosurg Spine 12:372–380
Zhu L, Yu XC, Lu CL (2013) A study on the biomechanical stability offered by interspinous fastener combined with interbody fusion for lower lumbar spine through three-dimensional finite element analysis. Orthop Biomech Mat Clin Study 10:55–60 (in Chinese)
McAfee PC (1999) Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880
Teo EC, Lee KK, Qiu TX, Ng HW, Yang K (2004) The biomechanics of lumbar graded facetectomy under anterior-shear load. IEEE Trans Biomed Eng 51:443–449
Kettler A, Liakos L, Haegele B, Wilke HJ (2007) Are the spines of calf, pig and sheep suitable models for pre-clinical implant tests? Eur Spine J 16:2186–2192
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Yu, X., Zhu, L. & Su, Q. Lumbar spine stability after combined application of interspinous fastener and modified posterior lumbar interbody fusion: a biomechanical study. Arch Orthop Trauma Surg 134, 623–629 (2014). https://doi.org/10.1007/s00402-014-1977-9
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DOI: https://doi.org/10.1007/s00402-014-1977-9