Biomechanics after spinal decompression and posterior instrumentation.
Biomechanics
Decompression
Fusion
Nucleotomy
Range of motion
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
19
09
2022
accepted:
28
03
2023
revised:
24
03
2023
medline:
5
6
2023
pubmed:
24
4
2023
entrez:
24
04
2023
Statut:
ppublish
Résumé
The aim of this study was to elucidate segmental range of motion (ROM) before and after common decompression and fusion procedures on the lumbar spine. ROM of fourteen fresh-frozen human cadaver lumbar segments (L1/2: 4, L3/4: 5, L5/S1: 5) was evaluated in six loading directions: flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression/distraction (AC). ROM was tested with and without posterior instrumentation under the following conditions: 1) native 2) after unilateral laminotomy, 3) after midline decompression, and 4) after nucleotomy. Median native ROM was FE 6.8°, LB 5.6°, and AR 1.7°, AS 1.8 mm, LS 1.4 mm, AC 0.3 mm. Unilateral laminotomy significantly increased ROM by 6% (FE), 3% (LB), 12% (AR), 11% (AS), and 8% (LS). Midline decompression significantly increased these numbers to 15%, 5%, 21%, 20%, and 19%, respectively. Nucleotomy further increased ROM in all directions, most substantially in AC of 153%. Pedicle screw fixation led to ROM decreases of 82% in FE, 72% in LB, 42% in AR, 31% in AS, and 17% in LS. In instrumented segments, decompression only irrelevantly affected ROM. The amount of posterior decompression significantly impacts ROM of the lumbar spine. The here performed biomechanical study allows creation of a simplified rule of thumb: Increases in segmental ROM of approximately 10%, 20%, and 50% can be expected after unilateral laminotomy, midline decompression, and nucleotomy, respectively. Instrumentation decreases ROM by approximately 80% in bending moments and accompanied decompression procedures only minorly destabilize the instrumentation construct.
Identifiants
pubmed: 37093262
doi: 10.1007/s00586-023-07694-5
pii: 10.1007/s00586-023-07694-5
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1876-1886Informations de copyright
© 2023. The Author(s).
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