Ivanov Alexander A, Kiapour Ali, Ebraheim Nabil A, Goel Vijay
Department of Orthopaedic Surgery and Bioengineering, Engineering Center for Orthopaedic Research Excellence (E-CORE), College of Medicine and Engineering, University of Toledo, Toledo, Ohio 43614, USA.
Spine (Phila Pa 1976). 2009 Mar 1;34(5):E162-9. doi: 10.1097/BRS.0b013e3181978ea3.
The assessment of sacrum angular motions and stress across sacroiliac joint (SIJ) articular surfaces using finite element lumbar spine-pelvis model and simulated posterior fusion surgical procedures.
To quantify the increase in sacrum angular motions and stress across SIJ as a function of fused lumbar spine using finite element lumbar spine-pelvis model.
A review of the literature suggests that for 20% to 30% of spine surgery patients, failed back surgery syndrome as a possible complication. The SIJ might be a contributing factor in failed back surgery syndrome in 29% to 40% of cases. The exact pathomechanism which leads to SIJ pain generation is not well understood. We hypothesized that lumbar spine fusion leads to increased motion or stresses at the SIJ; this alone could be a trigger of the pain syndrome.
A finite element model of the lumbar spine-pelvis was used to simulate the posterior fusion at L4-L5, L4-S1, and L5-S1 levels. The magnitude of the sacrum angular motion and average of stresses across SIJ articular surfaces were compared with intact model in flexion, extension, lateral bending, and axial rotation motions.
The computed sacrum angular motions in intact spine, after L4-L5, L5-S1, and L4-S1 fusion gradually increased with maximum value in L4-S1 fusion model. Also, the average stress on SIJ articular surfaces progressively increased from minimum in L4-L5 to maximum in L4-S1 fusion models.
The fusion at the lumbar spine level increased motion and stresses at the SIJ. This could be a probable reason for low back pain in patients after lumbar spine fusion procedures.
使用有限元腰椎-骨盆模型和模拟后路融合手术程序评估骶骨角运动和骶髂关节（SIJ）关节面的应力。
使用有限元腰椎-骨盆模型量化骶骨角运动增加以及SIJ应力随腰椎融合的变化情况。
文献综述表明，20%至30%的脊柱手术患者可能会出现腰椎手术失败综合征这一并发症。在29%至40%的病例中，SIJ可能是导致腰椎手术失败综合征的一个因素。导致SIJ疼痛产生的确切发病机制尚不清楚。我们假设腰椎融合会导致SIJ运动或应力增加；这本身可能是疼痛综合征的一个触发因素。
使用腰椎-骨盆有限元模型模拟L4-L5、L4-S1和L5-S1节段的后路融合。将骶骨角运动的大小和SIJ关节面应力的平均值与完整模型在屈曲、伸展、侧屈和轴向旋转运动中的情况进行比较。
完整脊柱、L4-L5、L5-S1和L4-S1融合后计算出的骶骨角运动逐渐增加，L4-S1融合模型中达到最大值。此外，SIJ关节面的平均应力从L4-L5融合时的最小值逐渐增加到L4-S1融合模型中的最大值。
腰椎节段融合会增加SIJ的运动和应力。这可能是腰椎融合手术后患者腰痛的一个可能原因。
