Experimental instability in the lumbar spine.

STUDY DESIGN

An in vivo animal model of lumbar segmental instability, involving both passive and active stabilizing components of the spine, was developed.

OBJECTIVE

The aim of this investigation was to dynamically study the alterations in segmental kinematics as a result of interventions to the passive stabilizing components and to the lumbar musculature.

SUMMARY OF BACKGROUND DATA

Segmental instability in the lumbar spine is associated with abnormal intervertebral motion. The majority of biomechanical studies have examined the in vitro effects of transecting individual stabilizing structures (i.e., intervertebral disc, facet joints, and ligaments), and have not simultaneously considered the effects of active musculature on spinal kinematics, which exist in the in vivo environment. Also, few studies have evaluated the kinematic behavior in the neutral region, for example, the transition phase between flexion and extension.

METHODS

Four experimental groups comprised 33 pigs, each of which followed different surgical injury sequences to the L3-L4 motion segment. An instrumented linkage attached to the L3-L4 motion segment was used to measure the sagittal kinematics during dynamic flexion-extension after each surgical injury and after bilateral stimulation of the lumbar paraspinal musculature.

RESULTS

Injuries to the disc resulted in greater overall axial translation. Graded injuries to the facet joint mainly caused changes in sagittal rotation and shear translation. When the facet injuries were compounded by removal of the transverse processes, there was significantly greater coupled motion and increased hysteresis in the neutral region for rotation. Extensive muscular stimulation after each of the injuries caused significantly greater rotation and shear translation, along with a tendency toward reduced axial translation, when compared to the unstimulated case. Although increasing the range of motion, increased muscular activity stabilized the injured motion segment by smoothing the erratic rotation pattern of motion, particularly in the neutral region.

CONCLUSIONS

Because of the direct attachment to the vertebrae, both passive and active strain from the musculature influence the spinal kinematics in normal or destabilized motion segments. Although increasing the range of motion, stimulation of the musculature surrounding the injured motion segment has a stabilizing effect by reducing abrupt kinematic behavior, particularly in the neutral region where the muscles are under reduced tension. A facetectomy produces a paradoxical kinematic behavior, which enhances the unstable condition of the motion segment. Surgical and rehabilitative treatments for patients with segmental instability need to consider the physiologic influences of the spinal musculature.