Lindsey Derek P, Kiapour Ali, Yerby Scott A, Goel Vijay K
SI-BONE, Inc. San Jose, CA.
Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH.
Int J Spine Surg. 2015 Nov 13;9:64. doi: 10.14444/2064. eCollection 2015.
Adjacent segment disease is a recognized consequence of fusion in the spinal column. Fusion of the sacroiliac joint is an effective method of pain reduction. Although effective, the consequences of sacroiliac joint fusion and the potential for adjacent segment disease for the adjacent lumbar spinal levels is unknown. The objective of this study was to quantify the change in range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments due to sacroiliac joint fusion and compare these changes to previous literature to assess the potential for adjacent segment disease in the lumbar spine.
An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the sacroiliac joint using three laterally placed triangular implants (iFuse Implant System, SI-BONE, Inc., San Jose, CA). The range of motion of the sacroiliac joint and the adjacent lumbar spinal motion segments were calculated using a hybrid loading protocol and compared with the intact range of motion in flexion, extension, lateral bending, and axial rotation.
The range of motions of the treated sacroiliac joints were reduced in flexion, extension, lateral bending, and axial rotation, by 56.6%, 59.5%, 27.8%, and 53.3%, respectively when compared with the intact condition. The stiffening of the sacroiliac joint resulted in increases at the adjacent lumbar motion segment (L5-S1) for flexion, extension, lateral bending, and axial rotation, of 3.0%, 3.7%, 1.1%, and 4.6%, respectively.
Fusion of the sacroiliac joint resulted in substantial (> 50%) reductions in flexion, extension, and axial rotation of the sacroiliac joint with minimal (< 5%) increases in range of motion in the lumbar spine. Although the predicted increases in lumbar range of motion are minimal after sacroiliac joint fusion, the long-term clinical results remain to be investigated.
相邻节段疾病是脊柱融合术公认的后果。骶髂关节融合是减轻疼痛的有效方法。尽管有效，但骶髂关节融合的后果以及相邻腰椎节段发生相邻节段疾病的可能性尚不清楚。本研究的目的是量化骶髂关节融合导致的骶髂关节活动度变化以及相邻腰椎运动节段的变化，并将这些变化与以往文献进行比较，以评估腰椎发生相邻节段疾病的可能性。
使用经实验验证的腰椎和骨盆有限元模型，采用三个侧向放置的三角形植入物（iFuse植入系统，SI-BONE公司，加利福尼亚州圣何塞）模拟骶髂关节融合。使用混合加载方案计算骶髂关节和相邻腰椎运动节段的活动度，并与屈曲、伸展、侧屈和轴向旋转时的完整活动度进行比较。
与完整状态相比，治疗后的骶髂关节在屈曲、伸展、侧屈和轴向旋转时的活动度分别降低了56.6%、59.5%、27.8%和53.3%。骶髂关节的僵硬导致相邻腰椎运动节段（L5-S1）在屈曲、伸展、侧屈和轴向旋转时分别增加了3.0%、3.7%、1.1%和4.6%。
骶髂关节融合导致骶髂关节在屈曲、伸展和轴向旋转方面大幅（>50%）降低，而腰椎活动度增加最小（<5%）。尽管骶髂关节融合后预测的腰椎活动度增加最小，但长期临床结果仍有待研究。
