Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T06:00:55.292Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiological and Mathematical Studies Regarding the Effects of Spinal Fixation on Kinematics and Mechanics at the Parafixed Segments

Published online by Cambridge University Press:  05 May 2011

S.-C. Lin ,
W.-C. Tsai ,
S.-S. Wu  and
P.-Q. Chen
S.-C. Lin*
Affiliation:
Institute of Biomedical Engineering, Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan 32001, R.O.C.
W.-C. Tsai*
Affiliation:
Department of Orthopedic Surgery, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan 11031 23561, R.O.C.
S.-S. Wu*
Affiliation:
Department of Orthopedic Surgery, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan 11031 23561, R.O.C.
P.-Q. Chen*
Affiliation:
Department of Orthopedic Surgery, Ming-Sheng General Hospital, Tau-Yuang, Taiwan 32082, R.O.C. Department of Orthopedic Surgery, National Taiwan University, Taipei, Taiwan 10617, R.O.C.
*
*Ph.D.
**M.D.
**M.D.
***Ph.D., M.D., corresponding author
Get access

Abstract

Spinal fixation and fusion has been adopted as a common procedure in spinal surgery. However, the degeneration as a result of parafixation may produce clinically significant problems. Previous studies have already shown increased loads, mobility, and intradiscal pressure at the parafixed segments. These may hasten the degeneration and instability of the neighboring segments. However, controversy remains regarding the correlation between surgical fixation and degeneration owing to parafixation. This study tried to elucidate their relationship by analyzing the in vivo roentgenograms of the post-fusion lumbar spine to measure the motion distribution of the fixed and adjacent unfused spinal segments. In addition, a mathematical model was developed to investigate the effects of implant fixation on the kinematics and mechanics at the parafixation segments.

The current radiological studies demonstrated that spinal fixation resulted in the redistribution of intersegmental mobility. The loss of flexion mobility at the fixed segments was unequally compensated for by the increased mobility at all adjacent free segments. This mechanical model can predict the redistribution patterns of mobility and stress at the parafixation segments. This redistribution depends on the fixation levels, implant rigidity, and subject predisposition. Additionally, such compensation was more marked in the tri-segmental than in the two-segment fixation, especially among patients who underwent greater spinal load.

This study concluded that the increased flexural rigidity at the fixed segment leads to the compensated kinematic and mechanical demands upon the unfixed adjacent segments. Accordingly, the cumulative effects of such increased mobility and loadings on the adjacent segments could be logically postulated to be the principal causes of accelerated degeneration of the adjacent lumbar segments, both upper and lower portions, subsequent to fusion surgery.

Keywords

Spinal fixationDegenerationAdjacent segmentBeam-column theory.
Type
Articles
Information
Journal of Mechanics , Volume 26 , Issue 3 , September 2010 , pp. 413 - 422
Copyright
Copyright © The Society of Theoretical and Applied Mechanics, R.O.C. 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ishihara, H., Osada, R., Kanamori, M., Kawaguchi, Y., Ohmori, K., Kimura, T., Matsu, H. and Tsuji, H., “Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Isthmic Spondylolisthesis,” Journal of Spinal Disorders & Techniques, 14, pp. 91–99 (2001).CrossRefGoogle Scholar
2.Yang, J. Y., Lee, J. K. and Song, H. S., “The Impact of Adjacent Segment Degeneration on the Clinical Outcome after Lumbar Spinal Fusion,” Spine, 33, pp. 503–507 (2008).CrossRefGoogle Scholar
3.Schulte, T. L., Leistra, F., Bullmann, V., Osada, N., Vieth, V., Marquardt, B., Lerner, T., Liljenqvist, U. and Hackenberg, L., “Disc Height Reduction in Adjacent Segments and Clinical Outcome 10 Years after Lumbar 360 Degrees Fusion,” European Spine Journal, 16, pp. 2152–2158 (2007).CrossRefGoogle Scholar
4.Kwon, B. K., Elgafy, H., Keynan, O., Fisher, C. G., Boyd, M. C, Paquette, S. J. and Dvorak, M. F., “Progressive Junctional Kyphosis at the Caudal End of Lumbar Instrumented Fusion: Etiology, Predictors, and Treatment,” Spine, 31, pp. 1943–1951 (2006).CrossRefGoogle Scholar
5.Etebar, S. and Cahill, D. W., “Risk Factors for Adjacent-Segment Failure Following Lumbar Fixation with Rigid Instrumentation for Degenerative Instability,” Journal of Neurosurgery, 90, pp. 163–169 (1999).Google Scholar
6.Goffin, J., van Loon, J., Van Calenbergh, F. and Plets, C, “Long-Term Results after Anterior Cervical Fusion and Osteosynthetic Stabilization for Fractures and/or Dislocations of the Cervical Spine,” Journal of Spinal Disorders & Techniques, 8, pp. 500–508 (1995).CrossRefGoogle Scholar
7.Hoogendoorn, R. J., Helder, M. N., Wuisman, P. I., Bank, R A., Everts, V. E. and Smit, T. H., “Adjacent Segment Degeneration: Observations in a Goat Spinal Fusion Study,” Spine, 33, pp. 1337–1343 (2008).CrossRefGoogle Scholar
8.Hayashi, T., Arizono, T., Fujimoto, T., Moro-oka, T., Shida, J., Fukumoto, S. and Masuda, S., “Degenerative Change in the Adjacent Segments to the Fusion Site after Posterolateral Lumbar Fusion with Pedicle Screw Instrumentation—A Minimum 4-year Follow-up,” HukuokaActaMedica, 13, pp. 107–113 (2008).Google Scholar
9.Nakai, S., Yoshizawa, H. and Kobayashi, S., “Long-term Follow-up Study of Posterior Lumbar Interbody Fusion,” Journal of Spinal Disorders & Techniques, 12, pp. 293–299 (1999).Google Scholar
10.Natarajan, R. N., Andersson, G. B., Patwardhan, A. G. and Andriacchi, T. P., “Study on Effect of Graded Facetectomy on Change in Lumbar Motion Segment Torsional Flexibility using Three-dimensional Continuum Contact Representation for Facet Joints,” Journal of Biomechanical Engineering, 121, pp. 215–221 (1999).CrossRefGoogle Scholar
11.Schulitz, K. P., Assheuer, J. and Wehling, P., “Degeneration in the adjacent level above lumbar fusion,” Proceedings of International Society for the Study of the Lumbar Spine, p. 216 (1994).Google Scholar
12.Wimmer, C, Gluch, H., Krismer, M., Ogon, M. and Jesenko, R., “AP-Translation in the Proximal Disc Adjacent to Lumbar Spine Fusion: A Retrospective Comparison of Mono- and Polysegmental Fusion in 120 Patients,” Acta Orthopaedica Scandinavica, 68, pp. 269–272 (1997).CrossRefGoogle Scholar
13.Yoganandan, N., Pintar, F. and Maiman, D. J., “Kinematics of the Lumbar Spine Following Pedicle Screw Plate Fusion,” Spine, 18, pp. 504–512 (1993).CrossRefGoogle Scholar
14.Chow, D. H., Luk, K. D., Evans, J. H. and Leong, J. C, “Effects of Short Anterior Lumbar Interbody Fusion on Biomechanics of Neighboring Unfused Segments,” Spine, 21, pp. 549–555 (1996).CrossRefGoogle Scholar
15.Wimmer, C, Gluch, H., Krismer, M., Ogon, M. and Jesenko, R., “AP-Translation in the Proximal Disc Adjacent to Lumbar Spine Fusion: A Retrospective Comparison of Mono- and Polysegmental Fusion in 120 Patients,” Acta Orthopaedica Scandinavica, 68, pp. 269–272 (1997).CrossRefGoogle Scholar
16.Hilibrand, A. S., Carlson, G. D., Palumbo, M. A., Jones, P. K. and Bohlman, H. H., “Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis,” The Journal of Bone and Joint Surgery, 84–A, pp. 519–528 (1999).CrossRefGoogle Scholar
17.Dvorak, J., Panjabi, M. M., Novotny, J. E., Chang, D. G. and Grob, D., “Clinical Validation of Functional Flexion-extension Roentgenograms of the Lumbar Spine,” Spine, 16, pp. 943–950 (1991).CrossRefGoogle Scholar
18.Lin, R M., Yu, C. Y., Chang, Z. J., Lee, C. C. and Su, F. C, “Flexion-extension Rhythm in the Lumbosacral Spine,” Spine, 19, pp. 2204–2209 (1994).CrossRefGoogle Scholar
19.Miyasaka, K., Kazuo, O., Suzuki, K. and Inoue, H., “Radiographic Analysis of Lumbar Motion in Relation to Lumbosacral Stability,” Spine, 25, pp. 732–737 (2000).CrossRefGoogle Scholar
20.Putto, E. and Tallroth, K., “Extension-flexion Radiographs for Motion Sstudies of the Lumbar Spine: A Comparison of Two Methods,” Spine, 15, pp. 107–110 (1990).CrossRefGoogle Scholar
21.Shono, Y., Kaneda, K., Abumi, K., McAfee, P. C. and Cunningham, B. W., “Stability of Posterior Spinal Instrumentation and its Effects on Adjacent Motion Segments in the Lumbosacral Spine,” Spine, 23, pp. 1550–1558 (1998).CrossRefGoogle Scholar
22.Johnsson, R., Axelsson, P., Gunnarsson, G. and Stromqvist, B., “Stability of Lumbar Fusion with Transpedicular Fixation Determined by Roentgen Stereophotogrammetric Analysis,” Spine, 24, pp. 687–690 (1999).CrossRefGoogle Scholar
23.Rohlmann, A., Calisse, J., Bergmann, G. and Weber, U., “Internal Spinal Fixator Stiffness has Only a Minor Influence on Stresses in the Adjacent Discs,” Spine, 24, pp. 1192–1196 (1999).CrossRefGoogle Scholar
24.Gilad, I. and Nissan, M., “A Study of Vertebra and Disc Geometric Relations of the Human Cervical and Lumbar Spine,” Spine, 11, pp. 154–157 (1986).CrossRefGoogle Scholar
25.Guyer, D. W., Yuan, H. A., Werner, F. W., Frederickson, B. E. and Murphy, D., “Biomechanical Comparison of Seven Internal Fixation Devices for the Lumbosacral Junction,” Spine, 12, pp. 569–573 (1987).CrossRefGoogle Scholar
26.Cunningham, B. W., Kotani, Y., McNulty, P. S., Cappuccino, A. and McAfee, P. C, “The Effect of Spinal Destabilization and Instrumentation on Lumbar Intradiscal Pressure: An in vitro Biomechanical Analysis,” Spine, 22, pp. 2655–2663 (1997).CrossRefGoogle Scholar
27.Schlegel, J. D., Smith, J. A. and Schleusener, R. L., “Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions,” Spine, 21, pp. 970–981 (1996).CrossRefGoogle Scholar
28.Pihlajamaki, H., Myllynen, . and Bostman, O., “Complications of Transpedicular Lumbosacral Fixation for Non-traumatic Disorders,” The Journal of Bone and Joint Surgery, 79–B, pp. 183–189 (1997).CrossRefGoogle Scholar
29.Hsu, K. Y., Zucherman, J., White, A., Reynolds, J. and Goldthwaite, N, “Deterioration of Motion Segments Adjacent to Lumbar Spine Fusion,” Annual Meeting of the North American Spine Society, Colorado Spring, Colorado, pp. 24–27 (1988).Google Scholar
30.Louis, R., “Fusion of the Lumbar and Sacral Spine by Internal Fixation with Screw Plates,” Clinical Orthopaedics and Related Research, 203, pp. 18–33 (1986).CrossRefGoogle Scholar
31.Lehmann, T. R., Spratt, K. F., Tozzi, J. E., Weinstein, J. N., Reinarz, S. J., El-Khoury, G. Y. and Colby, H., “Long-term Follow-up of Lumbar Fusion Patients,” Spine, 12, pp. 97–104 (1987).CrossRefGoogle Scholar
32.El-Bohy, A. A., Yang, K. H. and King, A. I., “Experimental Verification of Facet Load Transmission by Direct Measurement of Facet Lamina Contact Pressure,” Journal of Biomechanical Engineering, 22, pp. 931–941 (1998).CrossRefGoogle Scholar
33.Anderson, C. K., Chaffin, D. B. and Herrin, G. D., “A Study of Lumbosacral Orientation under Varied Static Loads,” Spine, 11, pp. 456–462 (1986).CrossRefGoogle Scholar