Lee Chang-Hyun, Kim Young Eun, Lee Hak Joong, Kim Dong Gyu, Kim Chi Heon
1Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Gyeonggi-do.
2Department of Mechanical Engineering, Dankook University, Yongin-si, Gyeonggi-do; and.
J Neurosurg Spine. 2017 Dec;27(6):643-649. doi: 10.3171/2017.3.SPINE161169. Epub 2017 Sep 22.
OBJECTIVE Pedicle screw-rod-based hybrid stabilization (PH) and interspinous device-based hybrid stabilization (IH) have been proposed to prevent adjacent-segment degeneration (ASD) and their effectiveness has been reported. However, a comparative study based on sound biomechanical proof has not yet been reported. The aim of this study was to compare the biomechanical effects of IH and PH on the transition and adjacent segments. METHODS A validated finite element model of the normal lumbosacral spine was used. Based on the normal model, a rigid fusion model was immobilized at the L4-5 level by a rigid fixator. The DIAM or NFlex model was added on the L3-4 segment of the fusion model to construct the IH and PH models, respectively. The developed models simulated 4 different loading directions using the hybrid loading protocol. RESULTS Compared with the intact case, fusion on L4-5 produced 18.8%, 9.3%, 11.7%, and 13.7% increments in motion at L3-4 under flexion, extension, lateral bending, and axial rotation, respectively. Additional instrumentation at L3-4 (transition segment) in hybrid models reduced motion changes at this level. The IH model showed 8.4%, -33.9%, 6.9%, and 2.0% change in motion at the segment, whereas the PH model showed -30.4%, -26.7%, -23.0%, and 12.9%. At L2-3 (adjacent segment), the PH model showed 14.3%, 3.4%, 15.0%, and 0.8% of motion increment compared with the motion in the IH model. Both hybrid models showed decreased intradiscal pressure (IDP) at the transition segment compared with the fusion model, but the pressure at L2-3 (adjacent segment) increased in all loading directions except under extension. CONCLUSIONS Both IH and PH models limited excessive motion and IDP at the transition segment compared with the fusion model. At the segment adjacent to the transition level, PH induced higher stress than IH model. Such differences may eventually influence the likelihood of ASD.
目的 椎弓根螺钉-棒系统混合固定(PH)和棘突间装置混合固定(IH)已被用于预防相邻节段退变(ASD),且其有效性已有报道。然而,基于可靠生物力学证据的对比研究尚未见报道。本研究旨在比较IH和PH对过渡节段及相邻节段的生物力学影响。方法 使用经过验证的正常腰骶椎有限元模型。基于正常模型,通过刚性固定器在L4-5节段进行刚性融合固定。分别在融合模型的L3-4节段添加DIAM或NFlex模型构建IH和PH模型。所构建的模型采用混合加载方案模拟4种不同加载方向。结果 与完整模型相比,L4-5节段融合后,L3-4节段在屈曲、伸展、侧弯和轴向旋转时的运动分别增加了18.8%、9.3%、11.7%和13.7%。混合模型中L3-4(过渡节段)额外的内固定减少了该节段的运动变化。IH模型在该节段的运动变化为8.4%、-33.9%、6.9%和2.0%,而PH模型为-30.4%、-26.7%、-23.0%和12.9%。在L2-3(相邻节段),与IH模型相比,PH模型的运动增加了14.3%、3.4%、15.0%和0.8%。与融合模型相比,两种混合模型在过渡节段的椎间盘内压力(IDP)均降低,但在L2-3(相邻节段),除伸展外,所有加载方向的压力均升高。结论 与融合模型相比,IH和PH模型均限制了过渡节段的过度运动和IDP。在过渡节段相邻的节段,PH比IH模型产生更高的应力。这些差异最终可能影响ASD的发生可能性。
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