Department of Spine Surgery, Central South University Third Xiangya Hospital, Changsha, China.
J Orthop Surg Res. 2024 Apr 1;19(1):209. doi: 10.1186/s13018-024-04681-4.
BACKGROUND: Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis. PURPOSE: Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS). METHODS: Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment. RESULTS: The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models. CONCLUSION: Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models.
背景:先前的研究已经证实了单纯减压治疗下等级较低的脊椎滑脱症的临床疗效。但同时也观察到,这种治疗方法的手术修正率较高,而缓解背痛的效果较低。然而,对于下等级脊椎滑脱症单纯减压后,目前缺乏相关的生物力学证据。
目的:通过分析运动范围(ROM)、椎间盘内压力(IDP)、纤维环应力(AFS)、关节突关节接触力(FJCF)和峡部应力(IS),评估全椎板切除术、半椎板切除术和部分关节突切除术治疗下等级脊椎滑脱症的生物力学特征。
方法:首先,我们利用有限元工具建立了一个正常的腰椎模型,然后基于正常模型构建了一个脊椎滑脱症模型。接着,我们分别在正常模型和脊椎滑脱症模型中进行了全椎板切除术、半椎板切除术和三分之一关节突切除术。最后,在相同的集中力和力矩下,我们对所有模型的 ROM、IDP、AFS、FJCF 和 IS 等参数进行了分析。
结果:完整的脊椎滑脱症模型相对于完整的正常腰椎模型,ROM、AFS、FJCF 和 IS 等相对参数显著增加。在脊椎滑脱症和正常腰椎模型中进行半椎板切除术和三分之一关节突切除术,与术前状态相比,ROM、IDP、AFS、FJCF 和 IS 并没有明显改变。此外,在进行相同的手术程序后,脊椎滑脱症和正常腰椎模型之间的参数变化程度没有显著差异。然而,全椎板切除术显著增加了正常腰椎模型和脊椎滑脱症模型的 ROM、AFS 和 IS,同时降低了 FJCF。
结论:半椎板切除术和三分之一关节突切除术对下等级脊椎滑脱症的节段稳定性没有显著影响;但是,接受半椎板切除术和三分之一关节突切除术的 LDS 患者在旋转时,可能会在手术侧经历更高的峡部应力。此外,全椎板切除术改变了正常腰椎模型和脊椎滑脱症模型的生物力学特性。
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