He Lipeng, Zhu Tingchen, Cai Weiye, Yang Wenhao, Chen Zan, Li Jingchi
Department of Orthopaedics Jiangsu CM Clinical Innovation Center of Degenerative Bone & Joint Disease, Wuxi TCM Hospital Affiliated to Nanjing University of chinese Medicine Wuxi Jiangsu Province People's Republic of China.
Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital Southwest Medical University Luzhou Sichuan Province People's Republic of China.
JOR Spine. 2025 Jan 7;8(1):e70030. doi: 10.1002/jsp2.70030. eCollection 2025 Mar.
There are differences in the extent of excision of articular processes, spinal processes and posterior ligamentum complexes (PLC) for posterior approach lumbar interbody fusion. Given that the biomechanical significance of these structures has been verified and that deterioration of the biomechanical environment is the main trigger for complications in both fused and adjacent motion segments, changes in decompression ranges may affect the potential risk of adjacent segmental disease (ASD) biomechanically; however, this topic has yet to be identified.
Posterior lumbar interbody fusion (PLIF) with different decompression strategies was simulated in a well-validated lumbosacral model. The excision and preservation of the cranial motion of the segmental PLC and the lateral articular process in the fusion segment were simulated in this model. The stress distribution in the cranial motion segment was computed under different loading conditions to determine the potential risk of ASD.
Compared to complete bilateral articular process excision, preservation of the lateral two-thirds of the articular process did not alleviate stress concentration on the cranial motion segment both in PLC preserved and excised models. In contrast, preservation of the cranial segmental PLC can obviously alleviate the stress concentration tendency of the cranial intervertebral disc under flexion loading conditions.
Preservation of the lateral parts of the articular process cannot optimize the biomechanical environment, in contrast, PLC preservation can effectively alleviate ASD related biomechanical deterioration of the cranium segment.
后路腰椎椎间融合术中，关节突、棘突及后韧带复合体（PLC）的切除范围存在差异。鉴于这些结构的生物力学意义已得到证实，且生物力学环境恶化是融合节段及相邻运动节段并发症的主要诱因，减压范围的改变可能会在生物力学方面影响相邻节段疾病（ASD）的潜在风险；然而，这一话题尚未得到明确。
在一个经过充分验证的腰骶模型中模拟采用不同减压策略的后路腰椎椎间融合术（PLIF）。在该模型中模拟融合节段节段性PLC和外侧关节突的头侧运动的切除与保留情况。计算不同负荷条件下头侧运动节段的应力分布，以确定ASD的潜在风险。
与双侧关节突完全切除相比，在保留和切除PLC的模型中，保留外侧三分之二的关节突均未减轻头侧运动节段的应力集中。相比之下，保留头侧节段性PLC可明显减轻屈曲负荷条件下头侧椎间盘的应力集中趋势。
保留关节突的外侧部分并不能优化生物力学环境，相比之下，保留PLC可有效减轻ASD相关的颅骨节段生物力学恶化。
