Rasmussen John, Iversen Kristoffer, Engelund Bjørn Keller, Rasmussen Sten
Department of Materials and Production, Aalborg University, Aalborg, Denmark.
AnyBody Technology A/S, Aalborg, Denmark.
Front Bioeng Biotechnol. 2021 Oct 18;9:724854. doi: 10.3389/fbioe.2021.724854. eCollection 2021.
Fusion of spinal vertebrae can be accomplished by different surgical approaches. We investigated Traditional Open Spine Surgery (TOSS) versus Minimally Invasive Spine Surgery (MISS). While TOSS sacrifices spine muscles originating or inserting on the affected vertebrae, MISS seeks to minimize the approach-related morbidity and preserve the tendon attachments of the muscles in the area. We captured 3-D motions of the full body of one healthy subject performing a variety of 10 kg box lifting operations representing activities-of-daily-living that are likely to challenge the spine biomechanically. The motion data were transferred to a full-body biomechanical model with a detailed representation of the biomechanics of the spine, and simulations of the internal spine loads and muscle forces were performed under a baseline configuration and muscle configurations typical for TOSS respectively MISS for the cases of L3/L4, L4/L5, L5/S1, L4/S1 and L3/L5 fusions. The computational model was then used to investigate the biomechanical differences between surgeries. The simulations revealed that joint reaction forces are more affected by both surgical approaches for lateral lifting motions than for sagittal plane motions, and there are indications that individuals with fused joints, regardless of the approach, should be particularly careful with asymmetrical lifts. The MISS and TOSS approaches shift the average loads of different muscle groups in different ways. TOSS generally leads to higher post-operative muscle loads than MISS in the investigated cases, but the differences are smaller than could be expected, given the differences of surgical technique.
脊椎融合可以通过不同的手术方法来完成。我们研究了传统开放性脊柱手术（TOSS）与微创脊柱手术（MISS）。TOSS会牺牲起源于或附着在受影响椎骨上的脊柱肌肉，而MISS则力求将手术相关的发病率降至最低，并保留该区域肌肉的肌腱附着点。我们采集了一名健康受试者全身的三维运动数据，该受试者进行了各种10千克的提箱操作，这些操作代表了可能对脊柱生物力学构成挑战的日常生活活动。运动数据被传输到一个具有详细脊柱生物力学表示的全身生物力学模型中，并分别在TOSS和MISS典型的肌肉配置下，针对L3/L4、L4/L5、L5/S1、L4/S1和L3/L5融合病例，在基线配置下对脊柱内部负荷和肌肉力量进行了模拟。然后使用该计算模型来研究手术之间的生物力学差异。模拟结果表明，对于侧向提升运动，两种手术方法对关节反应力的影响都比对矢状面运动的影响更大，并且有迹象表明，无论采用何种方法，关节融合的个体在不对称提升时都应格外小心。MISS和TOSS方法以不同方式改变了不同肌肉群的平均负荷。在所研究病例中，TOSS术后肌肉负荷通常比MISS高，但鉴于手术技术的差异，这种差异比预期的要小。
