Top

Published in:

01-08-2018 | Original Article

Biomechanical investigation of lumbar hybrid stabilization in two-level posterior instrumentation

Authors: Aldemar Andres Hegewald, Sebastian Hartmann, Alexander Keiler, Kai Michael Scheufler, Claudius Thomé, Werner Schmoelz

Published in: European Spine Journal | Issue 8/2018

Abstract

Purpose

Hybrid stabilization with a dynamic implant has been suggested to avoid adjacent segment disease by creating a smoother transition zone from the instrumented segments to the untreated levels above. This study aims to characterize the transition zones of two-level posterior instrumentation strategies for elucidating biomechanical differences between rigid fixation and the hybrid stabilization approach with a pedicle screw-based dynamic implant.

Methods

Eight human lumbar spines (L1–5) were loaded in a spine tester with pure moments of 7.5 Nm and with a hybrid loading protocol. The range of motion (ROM) of all segments for both loading protocols was evaluated and normalized to the native ROM.

Results

For pure moment loading, ROM of the segments cranial to both instrumentations were not affected by the type of instrumentation (p > 0.5). The dynamic instrumentation in L3–4 reduced the ROM compared to intact (p < 0.05) but allowed more motion than the rigid fixation of the same segment (p < 0.05). Under hybrid loading testing, the cranial segments (L1–2, L2–3) had a significant higher ROM for both instrumentations compared to the intact (p < 0.05). Comparing the two instrumentations with each other, the rigid fixation resulted in a higher increased ROM of L1–2 and L2–3 than hybrid stabilization.

Conclusions

Regardless of the implant, two-level posterior instrumentation was accompanied by a considerable amount of compensatory movement in the cranial untreated segments under the hybrid protocol. Hybrid stabilization, however, showed a significant reduction of this compensatory movement in comparison to rigid fixation. These results could support the surgical strategy of hybrid stabilization, whereas the concept of topping-off, including a healthy segment, is discouraged.

Sears WR, Sergides IG, Kazemi N, Smith M, White GJ, Osburg B (2011) Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 11:11–20. https://doi.org/10.1016/j.spinee.2010.09.026 CrossRefPubMed

Pan A, Hai Y, Yang J, Zhou L, Chen X, Guo H (2016) Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis. Eur Spine J 25:1522–1532. https://doi.org/10.1007/s00586-016-4415-6 CrossRefPubMed

Norvell DC, Dettori JR, Skelly AC, Riew KD, Chapman JR, Anderson PA (2012) Methodology for the systematic reviews on an adjacent segment pathology. Spine 37:10–17. https://doi.org/10.1097/BRS.0b013e31826cd9c8 CrossRef

Lawrence BD, Wang J, Arnold PM, Hermsmeyer J, Norvell DC, Brodke DS (2012) Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review. Spine 37:123–132. https://doi.org/10.1097/BRS.0b013e31826d60d8 CrossRef

He B, Yan L, Guo H, Liu T, Wang X, Hao D (2014) The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum follow-up. Spine 39:1093–1098. https://doi.org/10.1097/BRS.0000000000000353 CrossRefPubMed

Ou CY, Lee TC, Lee TH, Huang YH (2015) Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease. Neurosurgery 76:396–401. https://doi.org/10.1227/NEU.0000000000000627 CrossRefPubMed

Yamasaki K, Hoshino M, Omori K et al (2017) Risk factors of adjacent segment disease after transforaminal inter-body fusion for degenerative lumbar disease. Spine 42:E86–E92. https://doi.org/10.1097/BRS.0000000000001728 CrossRefPubMed

Wang H, Ma L, Yang D et al (2017) Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine 96:e6032. https://doi.org/10.1097/MD.0000000000006032 CrossRefPubMedPubMedCentral

Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P (2010) Dynamic stabilization adjacent to single-level fusion: part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J 19:2181–2189. https://doi.org/10.1007/s00586-010-1517-4 CrossRefPubMedPubMedCentral

10.

Strube P, Tohtz S, Hoff E, Gross C, Perka C, Putzier M (2010) Dynamic stabilization adjacent to single-level fusion: part I. Biomechanical effects on lumbar spinal motion. Eur Spine J 19:2171–2180. https://doi.org/10.1007/s00586-010-1549-9 CrossRefPubMedPubMedCentral

11.

Korovessis P, Repantis T, Zacharatos S, Zafiropoulos A (2009) Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J 18:830–840. https://doi.org/10.1007/s00586-009-0976-y CrossRefPubMedPubMedCentral

12.

Fleege C, Rickert M, Werner I, Rauschmann M, Arabmotlagh M (2016) Hybrid stabilization technique with spinal fusion and interlaminar device to reduce the length of fusion and to protect symptomatic adjacent segments: clinical long-term follow-up. Orthopade 45:770–779. https://doi.org/10.1007/s00132-016-3312-3 CrossRefPubMed

13.

Li C, Liu L, Shi JY, Yan KZ, Shen WZ, Yang ZR (2016) Clinical and biomechanical researches of polyetheretherketone (PEEK) rods for semi-rigid lumbar fusion: a systematic review. Neurosurg Rev. https://doi.org/10.1007/s10143-016-0763-2 CrossRefPubMed

14.

Andrieu K, Allain J, Longis PM, Steib JP, Beaurain J, Delécrin J (2017) Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of 2 years. Orthop Traumatol Surg Res 103:39–43. https://doi.org/10.1016/j.otsr.2016.06.018 CrossRefPubMed

15.

Tachibana N, Kawamura N, Kobayashi D et al (2017) Preventive effect of dynamic stabilization against adjacent segment degeneration after posterior lumbar interbody fusion. Spine 42:25–32. https://doi.org/10.1097/BRS.0000000000001654 CrossRefPubMed

16.

Wilke HJ, Heuer F, Schmidt H (2009) Prospective design delineation and subsequent in vitro evaluation of a new posterior dynamic stabilization system. Spine 34:255–261. https://doi.org/10.1097/BRS.0b013e3181920e9c CrossRefPubMed

17.

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 9:472–485CrossRefPubMedPubMedCentral

18.

Lange T, Schmoelz W, Gosheger G et al (2017) Is a gradual reduction of stiffness on top of posterior instrumentation possible with a suitable proximal implant? A biomechanical study. Spine J. https://doi.org/10.1016/j.spinee.2017.03.021 PubMedCrossRef

19.

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 7:148–154CrossRefPubMedPubMedCentral

20.

Panjabi MM (2007) Hybrid multidirectional test method to evaluate spinal adjacent-level effects. Clin Biomech 22:257–265. https://doi.org/10.1016/j.clinbiomech.2006.08.006 CrossRef

21.

Schmoelz W, Huber JF, Nydegger T, 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 16:418–423CrossRefPubMed

22.

Volkheimer D, Malakoutian M, Oxland TR, Wilke HJ (2015) Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature. Eur Spine J 24:1882–1892. https://doi.org/10.1007/s00586-015-4040-9 CrossRefPubMed

23.

Mageswaran P, Techy F, Colbrunn RW, Bonner TF, McLain RF (2012) Hybrid dynamic stabilization: a biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine. J Neurosurg Spine 17:232–242. https://doi.org/10.3171/2012.6.SPINE111054 CrossRefPubMed

24.

Cheng BC, Gordon J, Cheng J, Welch WC (2007) Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion. Spine 32:2551–2557. https://doi.org/10.1097/BRS.0b013e318158cdbe CrossRefPubMed

25.

Malakoutian M, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T (2016) Role of muscle damage on loading at the level adjacent to a lumbar spine fusion: a biomechanical analysis. Eur Spine J 25:2929–2937. https://doi.org/10.1007/s00586-016-4686-y CrossRefPubMed

Title: Biomechanical investigation of lumbar hybrid stabilization in two-level posterior instrumentation
Authors: Aldemar Andres Hegewald
Sebastian Hartmann
Alexander Keiler
Kai Michael Scheufler
Claudius Thomé
Werner Schmoelz
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5415-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Biomechanical investigation of lumbar hybrid stabilization in two-level posterior instrumentation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2018

Psychometric validation of the cross-culturally adapted traditional Chinese version of the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ)

Macrophage polarization contributes to local inflammation and structural change in the multifidus muscle after intervertebral disc injury

Timing of surgery in traumatic spinal cord injury: a national, multidisciplinary survey

Announcements

Letter to the Editor concerning “Minimally invasive surgery procedure in isthmic spondylolisthesis” by F.C. Tamburrelli et al. (Eur Spine J; 2018: doi:10.1007/s00586-018-5627-8)

Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review