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Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis.
Journal of Orthopaedic Surgery and Research ( IF 2.8 ) Pub Date : 2020-07-29 , DOI: 10.1186/s13018-020-01812-5
Teng Lu 1, 2 , Yi Lu 1
Affiliation  

Interlaminar stabilization and interspinous stabilization are two newer minimally invasive methods for lumbar spine stabilization, used frequently in conjunction with lumbar decompression to treat lumbar stenosis. The two methods share certain similarities, therefore, frequently being categorized together. However, the two methods offer distinct biomechanical properties, which affect their respective effectiveness and surgical success. To compare the biomechanical characteristics of interlaminar stabilization after lumbar decompression (ILS) and interspinous stabilization after lumbar decompression (ISS). For comparison, lumbar decompression alone (DA) and decompression with instrumented fusion (DF) were also included in the biomechanical analysis. Four finite element models were constructed, i.e., DA, DF, ISS, and ILS. To minimize device influence and focus on the biomechanical properties of different methods, Coflex device as a model system was placed at different position for the comparison of ISS and ILS. The range of motion (ROM) and disc stress peak at the surgical and adjacent levels were compared among the four surgical constructs. The stress peak of the spinous process, whole device, and device wing was compared between ISS and ILS. Compared with DA, the ROM and disc stress at the surgical level in ILS or ISS were much lower in extension. The ROM and disc stress at the surgical level in ILS were 1.27° and 0.36 MPa, respectively, and in ISS 1.51°and 0.55 MPa, respectively in extension. This is compared with 4.71° and 1.44 MPa, respectively in DA. ILS (2.06–4.85° and 0.37–0.98 MPa, respectively) or ISS (2.07–4.78° and 0.37–0.98 MPa, respectively) also induced much lower ROM and disc stress at the adjacent levels compared with DF (2.50–7.20° and 0.37–1.20 MPa, respectively). ILS further reduced the ROM and disc stress at the surgical level by 8% and 25%, respectively, compared to ISS. The stress peak of the spinous process in ILS was significantly lower than that in ISS (13.93–101 MPa vs. 31.08–172.5 MPa). In rotation, ILS yielded a much lower stress peak in the instrumentation wing than ISS (128.7 MPa vs. 222.1 MPa). ILS and ISS partly address the issues of segmental instability in DA and hypermobility and overload at the adjacent levels in DF. ILS achieves greater segmental stability and results in a lower disc stress, compared to ISS. In addition, ILS reduces the risk of spinous process fracture and device failure.

中文翻译:

与腰椎减压后的棘突间稳定相比,层间稳定提供了更大的生物力学优势:有限元分析。

层间稳定和棘突间稳定是腰椎稳定的两种较新的微创方法,经常与腰椎减压结合使用以治疗腰椎狭窄。这两种方法具有某些相似之处,因此经常被归类在一起。然而,这两种方法提供了独特的生物力学特性,这影响了它们各自的有效性和手术成功率。比较腰椎减压(ILS)后椎板间稳定和腰椎减压(ISS)椎间稳定的生物力学特征。为了进行比较,生物力学分析还包括单独的腰椎减压(DA)和采用器械融合的减压(DF)。构造了四个有限元模型,即DA,DF,ISS和ILS。为了最大程度地减少设备影响并关注不同方法的生物力学特性,将Coflex设备作为模型系统放置在不同位置,以比较ISS和ILS。比较了四种手术结构在手术和邻近部位的运动范围(ROM)和椎间盘应力峰值。比较了ISS和ILS之间棘突,整个装置和装置翼的应力峰值。与DA相比,ILS或ISS手术水平的ROM和椎间盘应力在延伸方面要低得多。ILS手术水平的ROM和椎间盘应力分别为1.27°和0.36 MPa,而ISS的拉伸应力分别为1.51°和0.55 MPa。分别与DA中的4.71°和1.44 MPa相比较。ILS(分别为2.06-4.85°和0.37-0.98 MPa)或ISS(2.07-4.78°和0.37-0.98 MPa,与DF相比(分别为2.50–7.20°和0.37–1.20 MPa),在相邻的水平上,ROM和光盘应力也要低得多。与ISS相比,ILS在手术水平上进一步将ROM和椎间盘应力降低了8%和25%。ILS棘突的应力峰值显着低于ISS(13.93–101 MPa与31.08–172.5 MPa)。在旋转中,ILS在仪表板机翼中产生的应力峰值比ISS低(128.7 MPa对222.1 MPa)。ILS和ISS部分地解决了DA的节段性不稳定性以及DF相邻级别的过度机动和超载的问题。与ISS相比,ILS可实现更高的节段稳定性并降低椎间盘应力。此外,ILS降低了棘突骨折和装置故障的风险。
更新日期:2020-07-29
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