Biomechanical testing of the locking axial lumbosacral interbody fusion

doi:10.3969/j.issn.2095-4344.1328

Abstract

Abstract:

BACKGROUND: In the 21^stcentury, domestic and foreign scholars have carried out a lot of basic and clinical researches on L₅-S₁ simple axial fusion internal fixation, which prove that its technology is minimally invasive, is conducive to the successful fusion of bone grafting and can meet the physiological needs of human body, but its anti-rotation fixation is poor. Therefore, a new internal fixation device that is both minimally invasive and stable is needed.

OBJECTIVE: To evaluate the biomechanical stability of the locking axial lumbosacral interbody fusion, so as to provide experimental data for future clinical usage.

METHODS: Five fresh human lumbar spines (L₃-S₅) were tested by applying pure moments. Each specimen was tested for the following order: normal control group; bilateral spondylolysis; locking AxiaLIF and bilateral spondylolysis; AxiaLIF and bilateral spondylolysis; AxiaLIF, bilateral pedicle screws and bilateral spondylolysis. The L₅/S₁ range of motion was obtained by applying pure moments in flexion, extension, lateral bending, axial rotation and axial compression loaded with 300 N force. The study was approved by the ethics committee of the hospital.

RESULTS AND CONCLUSION: (1) Spondylolysis significantly increased the range of motion in flexion-extension and axial rotation compared with the normal control group (P < 0.05). The two groups showed no significant difference in the lateral bending (P > 0.05). (2) Three kinds of fixation ways significantly reduced the range of motion in flexion-extension and lateral bending compared with the normal control group (P < 0.05). In flexion-extension, the combined fixation and locking AxiaLIF groups significantly reduced the range of motion compared with the screw group (P < 0.05), and there was no significant difference between combined fixation and locking AxiaLIF groups (P > 0.05). (3) In lateral bending, the range of motion in the locking AxiaLIF ROM group had no significant difference compared with the other fixation groups (P > 0.05), but the combined group significantly reduced the range of motion compared with the screw group (P < 0.05). (4) Locking AxiaLIF and combined groups significantly reduced the range of motion in axial rotation compared with the normal control group (P < 0.05), and there was no significant difference between screw and normal control groups (P > 0.05). Screw group significantly increased the range of motion in axial rotation compared with the combined group (P < 0.05). In the locking group, there was no significant difference between left axial rotation and right axial rotation (P > 0.05). (5) Three fixation groups significantly increased the axial compressive stiffness compared with the normal control group (P < 0.05), but there was no significant difference among three fixation groups (P > 0.05). (6) These results indicate that the locking axial lumbosacral interbody fusion can significantly enhance the stability of lumbosacral vertebral instability in all loading modes. It provides an effective solution for the question that the AxaiLIF has a poor stability in axial rotation.

Key words: minimal invasion, presacral approach, spinal fusion, internal fixation, biomechanics, the National Natural Science Foundation of China

CLC Number:

R459.9|R681.5|R318

Yi Guoliang, Wang Shankun, Song Xizheng. Biomechanical testing of the locking axial lumbosacral interbody fusion[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4546-4551.

Figures/Tables 5

References

[1]梁昌详,昌耘冰,顾宏林,等.动态内固定Coflex系统治疗腰椎退变性疾病:椎间孔高度恢复与疗效[J].中国组织工程研究, 2014, 18(13):2065-2070.

[2]Hallett A,Huntley JS,Gibson JN.Foraminal stenosis and single-evel degenerative disc disease:a randomized controlled trial comparing decomoression with decomprssion and instrumented fusion.Spine. 2007|32:1375-1380.

[3]Kepler CK, Anthony LY, Gruskay JA, et al. Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion. Spine J. 2013;13(5):489-497.

[4]Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine. 2003;28(15S): S26-S35.

[5]Zdeblick TA,Nachemson A,Obrien JP.Lumbar disc disease with discogenic pain.What surgical treatment is Most effective? Spine. 1996;21(15):1835-1838.

[6]Goldstein CL, Phillips FM, Rampersaud YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion. Spine. 2016; 41(1): S74-S89.

[7]舒小林,宋西正.AxiaLIF在腰骶椎融合治疗中的应用[J].中国组织工程研究,2018,22(3):456-463.

[8]Ahn J, Tabaraee E, Singh K. Minimally invasive transforaminal lumbar interbody fusion. J Spinal Disord Tech. 2015;28(6): 222-225.

[9]Cragg A, Carl A, Casteneda F, et al. New percutaneous access method for minimally invasive anterior lumbosacral surgery. J Spinal Disord Tech. 2004;17(1): 21-28.

[10]马向阳.腰骶椎带锁轴向融合固定的影像学研究[D].衡阳:南华大学,2013.

[11]田伟.脊柱与关节退行性疾病流行病学现状与诊疗发展[J].骨科临床与研究杂志,2016,1(1):1-3.

[12]Watanabe K.Treatment for patients with Charcot-Marie-Tooth disease: orthopaedic aspects.Brain Nerve. 2016;68(1) :51-57.

[13]Tsantrizos A, Ito K, Aebi M, et al. Internal strains in healthy and degenerated lumbar intervertebral discs. Spine. 2005; 30(19): 2129-2137.

[14]丁自海,杜心如.脊柱外科临床解剖学[M]. 济南:山东科学技术出版社,2008:25.

[15]Mihara H,Onari K,Cheng BC,et al.The biomechanical effects of spondylolysis and its treatment. Spine (Phila Pa 1976). 2003;28(3):235-238.

[16]Justin KS,Bakhsheshian J,Fakurnejad S,et al. Evidence based medicine of traumatic thoracolumbar burst fract ures:A systematic review of operative management across 20 years. Global Spine J. 2015;5(1):73-82.

[17]Crisco JJ.The biomechanicsal stability of the human lumbar spine: experimental and theoretical investigations]. USA: Yale university,1989.

[18]Stanley SK, Ghanayem AJ, Voronov LI, et al. Flexion-extension response of the thoracolumbar spine under compressive follower preload.Spine (Phila Pa 1976). 2004; 29(22):E510-514.

[19]谢勇,晏怡果.离体脊柱生物力学测试的加载方法研究进展[J].医用生物力学,2018,33(2):174-180.

[20]Bell KM,Hartman RA,Gilbertson LG,et al.In vitro spine testing using a robot-based testing system: comparison of displacement control and “hybrid control”.J Biomech. 2013; 46(10): 1663-1669.

[21]Goel VK,Wilder DG,Pope MH,et al. Biomechanical testing of the spine.Load-controlled versus displacementcontrolled analysis. Spine ( Phila Pa 1976).1995;20(21): 2354-2357.

[22]McAfeePC, Farey ID, Sutterlin TC. Theeffects of spinal implant rigidity on vertebral bonedensity: Acanine model. Spine. 1991;16:190-197.

[23]Tai CL,Hsieh PH,Chen WP,et al. Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome.An experimental study in porcine model. BMC Musculoskelet Disord. 2008;9(1): 1-9.

[24]易新,宋西正.腰骶椎带锁轴向融合内固定器的有限元分析[J].中国组织工程研究,2018,22(31):4982-4986.