Skip to main content
Top
Published in: European Spine Journal 5/2012

01-05-2012 | Original Article

Biomechanical evaluation of a posterior non-fusion instrumentation of the lumbar spine

Authors: Werner Schmoelz, Stefanie Erhart, Stefan Unger, Alexander C. Disch

Published in: European Spine Journal | Issue 5/2012

Login to get access

Abstract

Purpose

Numerous posterior non-fusion systems have been developed within the past decade to resolve the disadvantages of rigid instrumentations and preserve spinal motion. The aim of this study was to investigate the effect of a new dynamic stabilization device, to measure the screw anchorage after flexibility testing and compare it with data reported in the literature.

Methods

Six human lumbar spine motion segments (L2–5) were loaded in a spine tester with pure moments of 7.5 Nm in lateral bending, flexion/extension and axial rotation. Specimens were tested intact, after instrumentation of the intact segment, after destabilization by a nucleotomy and after instrumentation of the destabilised segment with the new non-fusion device (Elaspine). After flexibility testing all screws were subjected to a pull-out test.

Results

Instrumentation of the intact segment significantly reduced the RoM (p < 0.002) in flexion, extension and lateral bending to 49.7, 44.6 and 53% of the intact state, respectively. In axial rotation, the instrumentation resulted in a non-significant RoM reduction to 95% of the intact state. Compared to the intact segment, instrumentation of the destabilized segment significantly (p < 0.05) reduced the RoM to 69.8, 62.3 and 79.1% in flexion, extension and lateral bending, respectively. In axial rotation, the instrumented segment showed a significantly higher RoM than the intact segment (137.6% of the intact state (p < 0.01)). The pull-out test showed a maximum pull-out force of 855.1 N (±334) with a displacement of 6.1 mm (±2.8) at maximum pull-out force.

Conclusions

The effect of the investigated motion preservation device on the RoM of treated segments is in the range of other devices reported in the literature. Compared to the most implanted and investigated device, the Dynesys, the Elaspine has a less pronounced motion restricting effect in lateral bending and flexion/extension, while being less effective in limiting axial rotation. The pull-out force of the pedicle screws demonstrated anchorage comparable to other screw designs reported in the literature.
Literature
1.
2.
go back to reference Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26 (23):2521–2532; discussion 2532–2524 Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26 (23):2521–2532; discussion 2532–2524
3.
go back to reference Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976) 30 (20):2312–2320 Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine (Phila Pa 1976) 30 (20):2312–2320
4.
go back to reference Disch AC, Schmoelz W, Matziolis G, Schneider SV, Knop C, Putzier M (2008) Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions. J Spinal Disord Tech 21(2):79–85PubMedCrossRef Disch AC, Schmoelz W, Matziolis G, Schneider SV, Knop C, Putzier M (2008) Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions. J Spinal Disord Tech 21(2):79–85PubMedCrossRef
5.
go back to reference Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl):190S–194SPubMedCrossRef Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl):190S–194SPubMedCrossRef
6.
go back to reference Khoueir P, Kim KA, Wang MY (2007) Classification of posterior dynamic stabilization devices. Neurosurg Focus 22(1):E3PubMedCrossRef Khoueir P, Kim KA, Wang MY (2007) Classification of posterior dynamic stabilization devices. Neurosurg Focus 22(1):E3PubMedCrossRef
7.
go back to reference Gedet P, Haschtmann D, Thistlethwaite PA, Ferguson SJ (2009) Comparative biomechanical investigation of a modular dynamic lumbar stabilization system and the Dynesys system. Eur Spine J 18(10):1504–1511PubMedCrossRef Gedet P, Haschtmann D, Thistlethwaite PA, Ferguson SJ (2009) Comparative biomechanical investigation of a modular dynamic lumbar stabilization system and the Dynesys system. Eur Spine J 18(10):1504–1511PubMedCrossRef
8.
go back to reference Schmoelz W, Huber JF, Nydegger T, Dipl I, Claes L, Wilke HJ (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16(4):418–423PubMedCrossRef Schmoelz W, Huber JF, Nydegger T, Dipl I, Claes L, Wilke HJ (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16(4):418–423PubMedCrossRef
9.
go back to reference Knop C, Lange U, Bastian L, Blauth M (2000) Three-dimensional motion analysis with Synex. Comparative biomechanical test series with a new vertebral body replacement for the thoracolumbar spine. Eur Spine J 9(6):472–485PubMedCrossRef Knop C, Lange U, Bastian L, Blauth M (2000) Three-dimensional motion analysis with Synex. Comparative biomechanical test series with a new vertebral body replacement for the thoracolumbar spine. Eur Spine J 9(6):472–485PubMedCrossRef
10.
go back to reference Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine 13(10):1129–1134PubMedCrossRef Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine 13(10):1129–1134PubMedCrossRef
11.
go back to reference Wilke HJ, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7(2):148–154PubMedCrossRef Wilke HJ, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7(2):148–154PubMedCrossRef
12.
go back to reference Wilke HJ, Heuer F, Schmidt H (2009) Prospective design delineation and subsequent in vitro evaluation of a new posterior dynamic stabilization system. Spine (Phila Pa 1976) 34 (3):255–261 Wilke HJ, Heuer F, Schmidt H (2009) Prospective design delineation and subsequent in vitro evaluation of a new posterior dynamic stabilization system. Spine (Phila Pa 1976) 34 (3):255–261
13.
go back to reference Schmoelz W, Onder U, Martin A, von Strempel A (2009) Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment. Eur Spine J 18(10):1478–1485PubMedCrossRef Schmoelz W, Onder U, Martin A, von Strempel A (2009) Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment. Eur Spine J 18(10):1478–1485PubMedCrossRef
14.
go back to reference Schilling C, Kruger S, Grupp TM, Duda GN, Blomer W, Rohlmann A (2010) The effect of design parameters of dynamic pedicle screw systems on kinematics and load bearing: an in vitro study. Eur Spine J 20:297–307PubMedCrossRef Schilling C, Kruger S, Grupp TM, Duda GN, Blomer W, Rohlmann A (2010) The effect of design parameters of dynamic pedicle screw systems on kinematics and load bearing: an in vitro study. Eur Spine J 20:297–307PubMedCrossRef
15.
go back to reference Bozkus H, Senoglu M, Baek S, Sawa AG, Ozer AF, Sonntag VK, Crawford NR (2010) Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization. J Neurosurg Spine 12(2):183–189PubMedCrossRef Bozkus H, Senoglu M, Baek S, Sawa AG, Ozer AF, Sonntag VK, Crawford NR (2010) Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization. J Neurosurg Spine 12(2):183–189PubMedCrossRef
16.
go back to reference Niosi CA, Zhu QA, Wilson DC, Keynan O, Wilson DR, Oxland TR (2006) Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study. Eur Spine J 15(6):913–922PubMedCrossRef Niosi CA, Zhu QA, Wilson DC, Keynan O, Wilson DR, Oxland TR (2006) Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study. Eur Spine J 15(6):913–922PubMedCrossRef
17.
go back to reference Panjabi MM, Henderson G, James Y, Timm JP (2007) StabilimaxNZ) versus simulated fusion: evaluation of adjacent-level effects. Eur Spine J 16(12):2159–2165PubMedCrossRef Panjabi MM, Henderson G, James Y, Timm JP (2007) StabilimaxNZ) versus simulated fusion: evaluation of adjacent-level effects. Eur Spine J 16(12):2159–2165PubMedCrossRef
18.
go back to reference Schulte TL, Hurschler C, Haversath M, Liljenqvist U, Bullmann V, Filler TJ, Osada N, Fallenberg EM, Hackenberg L (2008) The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J 17(8):1057–1065PubMedCrossRef Schulte TL, Hurschler C, Haversath M, Liljenqvist U, Bullmann V, Filler TJ, Osada N, Fallenberg EM, Hackenberg L (2008) The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J 17(8):1057–1065PubMedCrossRef
19.
go back to reference Cunningham BW, Dawson JM, Hu N, Kim SW, McAfee PC, Griffith SL (2010) Preclinical evaluation of the Dynesys posterior spinal stabilization system: a nonhuman primate model. Spine J 10(9):775–783PubMedCrossRef Cunningham BW, Dawson JM, Hu N, Kim SW, McAfee PC, Griffith SL (2010) Preclinical evaluation of the Dynesys posterior spinal stabilization system: a nonhuman primate model. Spine J 10(9):775–783PubMedCrossRef
20.
go back to reference Ko CC, Tsai HW, Huang WC, Wu JC, Chen YC, Shih YH, Chen HC, Wu CL, Cheng H (2010) Screw loosening in the Dynesys stabilization system: radiographic evidence and effect on outcomes. Neurosurg Focus 28(6):E10PubMedCrossRef Ko CC, Tsai HW, Huang WC, Wu JC, Chen YC, Shih YH, Chen HC, Wu CL, Cheng H (2010) Screw loosening in the Dynesys stabilization system: radiographic evidence and effect on outcomes. Neurosurg Focus 28(6):E10PubMedCrossRef
21.
go back to reference Ianuzzi A, Kurtz SM, Kane W, Shah P, Siskey R, van Ooij A, Bindal R, Ross R, Lanman T, Buttner-Janz K, Isaza J (2010) In vivo deformation, surface damage, and biostability of retrieved Dynesys systems. Spine (Phila Pa 1976) 35 (23):E1310–E1316 Ianuzzi A, Kurtz SM, Kane W, Shah P, Siskey R, van Ooij A, Bindal R, Ross R, Lanman T, Buttner-Janz K, Isaza J (2010) In vivo deformation, surface damage, and biostability of retrieved Dynesys systems. Spine (Phila Pa 1976) 35 (23):E1310–E1316
22.
go back to reference Liu CL, Zhong ZC, Shih SL, Hung C, Lee YE, Chen CS (2010) Influence of Dynesys system screw profile on adjacent segment and screw. J Spinal Disord Tech 23(6):410–417PubMedCrossRef Liu CL, Zhong ZC, Shih SL, Hung C, Lee YE, Chen CS (2010) Influence of Dynesys system screw profile on adjacent segment and screw. J Spinal Disord Tech 23(6):410–417PubMedCrossRef
23.
go back to reference Meyers K, Tauber M, Sudin Y, Fleischer S, Arnin U, Girardi F, Wright T (2008) Use of instrumented pedicle screws to evaluate load sharing in posterior dynamic stabilization systems. Spine J 8(6):926–932PubMedCrossRef Meyers K, Tauber M, Sudin Y, Fleischer S, Arnin U, Girardi F, Wright T (2008) Use of instrumented pedicle screws to evaluate load sharing in posterior dynamic stabilization systems. Spine J 8(6):926–932PubMedCrossRef
24.
go back to reference Bozkus H, Senoglu M, Baek S, Sawa AG, Ozer AF, Sonntag VK, Crawford NR (2010) Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization. J Neurosurg Spine 12 (2):183–189 Bozkus H, Senoglu M, Baek S, Sawa AG, Ozer AF, Sonntag VK, Crawford NR (2010) Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization. J Neurosurg Spine 12 (2):183–189
25.
go back to reference Scifert JL, Sairyo K, Goel VK, Grobler LJ, Grosland NM, Spratt KF, Chesmel KD (1999) Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model. Spine (Phila Pa 1976) 24 (21):2206–2213 Scifert JL, Sairyo K, Goel VK, Grobler LJ, Grosland NM, Spratt KF, Chesmel KD (1999) Stability analysis of an enhanced load sharing posterior fixation device and its equivalent conventional device in a calf spine model. Spine (Phila Pa 1976) 24 (21):2206–2213
26.
go back to reference Bullmann V, Schmoelz W, Richter M, Grathwohl C, Schulte TL (2010) Revision of cannulated and perforated cement-augmented pedicle screws: a biomechanical study in human cadavers. Spine (Phila Pa 1976) 35:E932–E939 Bullmann V, Schmoelz W, Richter M, Grathwohl C, Schulte TL (2010) Revision of cannulated and perforated cement-augmented pedicle screws: a biomechanical study in human cadavers. Spine (Phila Pa 1976) 35:E932–E939
27.
go back to reference Masaki T, Sasao Y, Miura T, Torii Y, Kojima A, Aoki H, Beppu M (2009) An experimental study on initial fixation strength in transpedicular screwing augmented with calcium phosphate cement. Spine (Phila Pa 1976) 34 (20):E724–E728 Masaki T, Sasao Y, Miura T, Torii Y, Kojima A, Aoki H, Beppu M (2009) An experimental study on initial fixation strength in transpedicular screwing augmented with calcium phosphate cement. Spine (Phila Pa 1976) 34 (20):E724–E728
Metadata
Title
Biomechanical evaluation of a posterior non-fusion instrumentation of the lumbar spine
Authors
Werner Schmoelz
Stefanie Erhart
Stefan Unger
Alexander C. Disch
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 5/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-2121-y

Other articles of this Issue 5/2012

European Spine Journal 5/2012 Go to the issue