The Engineering Center for Orthopaedic Research Excellence (E-CORE), Toledo, OH, US.
Spine and Scoliosis Specialists, Tampa, FL, US.
Eur Spine J. 2021 Sep;30(9):2622-2630. doi: 10.1007/s00586-021-06909-x. Epub 2021 Jul 14.
PURPOSE: Lumbar procedures for Transforaminal Lumbar Interbody Fusion (TLIF) range from open (OS) to minimally invasive surgeries (MIS) to preserve paraspinal musculature. We quantify the biomechanics of cross-sectional area (CSA) reduction of paraspinal muscles following TLIF on the adjacent segments. METHODS: ROM was acquired from a thoracolumbar ribcage finite element (FE) model across each FSU for flexion-extension. A L4-L5 TLIF model was created. The ROM in the TLIF model was used to predict muscle forces via OpenSim. Muscle fiber CSA at L4 and L5 were reduced from 4.8%, 20.7%, and 90% to simulate muscle damage. The predicted muscle forces and ROM were applied to the TLIF model for flexion-extension. Stresses were recorded for each model. RESULTS: Increased ROM was present at the cephalad (L3-L4) and L2-L3 level in the TLIF model compared to the intact model. Graded changes in paraspinal muscles were seen, the largest being in the quadratus lumborum and multifidus. Likewise, intradiscal pressures and annulus stresses at the cephalad level increased with increasing CSA reduction. CONCLUSIONS: CSA reduction during the TLIF procedure can lead to adjacent segment alterations in the spinal element stresses and potential for continued back pain, postoperatively. Therefore, minimally invasive techniques may benefit the patient.
目的:经椎间孔腰椎体间融合术(TLIF)的腰椎手术范围从开放式(OS)到微创手术(MIS),以保留脊柱旁肌肉。我们量化了 TLIF 后相邻节段脊柱旁肌肉横截面积(CSA)减少的生物力学。 方法:通过每个 FSU 的胸腰椎肋骨有限元(FE)模型获得屈伸运动的 ROM。创建了 L4-L5 TLIF 模型。TLIF 模型中的 ROM 用于通过 OpenSim 预测肌肉力。从 4.8%、20.7%和 90%分别减少 L4 和 L5 的肌肉纤维 CSA 以模拟肌肉损伤。将预测的肌肉力和 ROM 应用于 TLIF 模型进行屈伸运动。记录每个模型的应力。 结果:与完整模型相比,TLIF 模型在头侧(L3-L4)和 L2-L3 水平的 ROM 增加。脊柱旁肌肉的变化呈分级变化,其中以腰方肌和多裂肌最为明显。同样,随着 CSA 减少的增加,头侧水平的椎间盘内压力和环带应力也增加。 结论:TLIF 手术过程中的 CSA 减少会导致脊柱节段的相邻节段应力发生变化,并可能导致术后持续背痛。因此,微创技术可能对患者有益。
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