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经椎间孔腰椎椎间融合术联合减压手术后小关节损伤的生物力学变化：一项有限元研究

The biomechanical changes of facet joint violation after transforaminal lumbar interbody fusion combined with decompression surgery: a finite element study.

作者信息

Chen Xing, Zhao Geng, Wang Xiaoxiong, Zhang Yuchen, Sun Junyuan, Zhang Xu, Liu Xinyu

机构信息

Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.

School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.

出版信息

Front Bioeng Biotechnol. 2025 Aug 1;13:1481719. doi: 10.3389/fbioe.2025.1481719. eCollection 2025.

DOI:10.3389/fbioe.2025.1481719
PMID:40821663
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12354452/
Abstract

INTRODUCTION: Facet joint violation (FJV) is a common complication of intervertebral fusion surgery, altering the load-bearing capability of the facet joints and ultimately contributing to segmental instability. Furthermore, adjacent segment degeneration is one of the potential long-term complications following lumbar spinal intervertebral fusion. For patients with a history of lumbar intervertebral fusion who developed symptomatic spinal stenosis at adjacent segments, adjacent segment decompression surgery is a clinically viable option. The biomechanical effects of isolated decompression surgery or intervertebral fusion surgery have been relatively well established. However, the biomechanical impact of facet joint intrusion on patients who have undergone both lumbar intervertebral fusion and adjacent segment decompression remains unclear. METHODS: The L4-L5 intervertebral fusion model (F) and the L3-L4 decompression with L4-L5 intervertebral fusion model (DF) were developed based on a validated intact L3-L5 model (I). On the basis of DF model, six FJV models were created according to the extent and grades of facet joint violation: left mild violation (LMV), left severe violation (LSV), right mild violation (RMV), right severe violation (RSV), bilateral mild violation (BMV), and bilateral severe violation (BSV). In each scenario, the range of motion (ROM) and intradiscal pressure (IDP) at the supra-adjacent segments were analyzed. RESULTS: The results indicated that both decompression and intervertebral fusion surgeries increased the ROM and intradiscal stress on the L3-L4 intervertebral discs. Additionally, the presence of facet joint violation further increased the ROM and intradiscal pressure on the L3-L4 segment, with these changes being associated with the grades and extent of facet joint violation, particularly when decompression and violation occurred on the same side. DISCUSSION: This study revealed that decompression or facet joint violation could elevate intradiscal pressure and ROM at the supra-adjacent segment, indicating a potential synergistic interaction between these two risk factors.

摘要

引言：小关节损伤（FJV）是椎间融合手术的常见并发症，会改变小关节的承重能力，最终导致节段性不稳定。此外，相邻节段退变是腰椎椎间融合术后潜在的长期并发症之一。对于有腰椎融合病史且在相邻节段出现症状性椎管狭窄的患者，相邻节段减压手术是一种临床上可行的选择。单纯减压手术或椎间融合手术的生物力学效应已经相对明确。然而，小关节损伤对接受过腰椎椎间融合术和相邻节段减压术的患者的生物力学影响仍不清楚。 方法：基于经过验证的完整L3-L5模型（I），建立了L4-L5椎间融合模型（F）和L3-L4减压联合L4-L5椎间融合模型（DF）。在DF模型的基础上，根据小关节损伤的程度和分级创建了六个FJV模型：左侧轻度损伤（LMV）、左侧重度损伤（LSV）、右侧轻度损伤（RMV）、右侧重度损伤（RSV）、双侧轻度损伤（BMV）和双侧重度损伤（BSV）。在每种情况下，分析相邻上位节段的活动范围（ROM）和椎间盘内压力（IDP）。 结果：结果表明，减压手术和椎间融合手术均增加了L3-L4椎间盘的ROM和椎间盘内应力。此外，小关节损伤的存在进一步增加了L3-L4节段的ROM和椎间盘内压力，这些变化与小关节损伤的分级和程度相关，尤其是当减压和损伤发生在同一侧时。 讨论：本研究表明，减压或小关节损伤可升高相邻上位节段的椎间盘内压力和ROM，表明这两个危险因素之间可能存在协同相互作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/4725c588f5c7/fbioe-13-1481719-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/c53f52d50746/fbioe-13-1481719-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/a4948c4d9440/fbioe-13-1481719-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/153634a806f8/fbioe-13-1481719-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/588d78b22fc1/fbioe-13-1481719-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/eb3143beabc3/fbioe-13-1481719-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/11a813c4ee33/fbioe-13-1481719-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/4725c588f5c7/fbioe-13-1481719-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/c53f52d50746/fbioe-13-1481719-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/a4948c4d9440/fbioe-13-1481719-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/153634a806f8/fbioe-13-1481719-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/588d78b22fc1/fbioe-13-1481719-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/eb3143beabc3/fbioe-13-1481719-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/11a813c4ee33/fbioe-13-1481719-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8715/12354452/4725c588f5c7/fbioe-13-1481719-g007.jpg

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本文引用的文献

[1]
Biomechanical Effects of Facet Joint Violation After Single-Level Lumbar Fusion With Transpedicular Screw and Rod Instrumentation.

Spine (Phila Pa 1976). 2023-7-15

[2]
The effect of interlaminar Coflex stabilization in the topping-off procedure on local and global spinal sagittal alignment.

BMC Musculoskelet Disord. 2023-2-11

[3]
Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis.

Spine J. 2022-6

[4]
Clinical Validity of 3 Different Grading Systems for Facet Joint Violation: A Retrospective Study and In-Depth Review.

Global Spine J. 2023-4

[5]
Risk of adjacent segment disease after 'topping-off' multi-level lumbar fusions with posterior dynamic stabilisers: an observational cohort study.

Eur Spine J. 2021-1

[6]
Safety and accuracy of robot-assisted placement of pedicle screws compared to conventional free-hand technique: a systematic review and meta-analysis.

Spine J. 2021-2

[7]
Facet joint violation after single-position versus dual-position lateral interbody fusion and percutaneous pedicle screw fixation: A comparison of two techniques.

J Clin Neurosci. 2020-6-30

[8]
Risk Factors Related to Superior Facet Joint Violation During Lumbar Percutaneous Pedicle Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF).

World Neurosurg. 2020-4-28

[9]
Superior-segment Bilateral Facet Violation in Lumbar Transpedicular Fixation, Part III: A Biomechanical Study of Severe Violation.

Spine (Phila Pa 1976). 2020-5-1

[10]
Factors Predictive of Adjacent Segment Disease After Lumbar Spinal Fusion.

World Neurosurg. 2019-9-27

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