Comparison study of the effect of fusion and non-fusion fixation on the movement of injured lumbar spine

doi:10.3969/j.issn.2095-4344.2017.31.008

Abstract

Abstract:

BACKGROUND: Degenerative change in lumbar spine is the natural physiological and pathological process with age increasing, which seriously affects the patients’ quality of life. Conventional surgical treatments may bring about some complications. Interspinous stabilization Coflex demonstrates good clinical outcomes, while there is lack of experimental evidence.

OBJECTIVE: To investigate the effect of fixation methods on the movement of lumbar vertebrae, and to provide reference for clinical operation from the aspect of biomechanics.

METHODS: Five fresh specimens of pig cadaveric lumbar spine were selected and divided into five groups: blank control group (group A), injury group (group B), L₃-L₄ Coflex fixed (group C), L₃-L₄ Coflex fixed plus decompression (group D), and L₃-L₄ intervertebral fusion fixed (group E). The biomechanical performance of the five lumbar specimens was tested in six loading directions of flexion/extension, left/right lateral bending, and left/right axial rotation driven by a robot system. The motion range of the operation segments (L₃-L₄) and the whole lumbar spine was observed by a multi-directional torque sensor combined with a three-dimensional motion capture system. Finally, the influence of lumber fixation methods on the spinal movement was explored.

RESULTS AND CONCLUSION: (1) For the range of three-dimensional angle at the operation segments (L₃-L₄), it was found that groups C and D were similar to group A, and groups B and E were quite different from group A. (2) Group E could restore the motion range of the injured segments, but the motion angle was much smaller than that in the groups C and D. (3) These results indicate that the motion angle of the injured spine treated with Coflex can restore to the normal state, with long-term stability. For unstable lumbar spine, interspinous Coflex is better than transforaminal lumbar interbody fusion, which can induce similar biomechanical properties to normal lumbar spine after operation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Biomechanics, Intervertebral Disk Degeneration, Internal Fixators

CLC Number:

R318

Song Hong-fang, Zhang Wen, Zhang Qiang, Liu Zhi-cheng. Comparison study of the effect of fusion and non-fusion fixation on the movement of injured lumbar spine[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 4963-4968.

Figures/Tables 1

5例样本的实验结果取平均值作为本文实验结果，包括5种模型在6种运动下手术节段的角度变化、整体标本的运动角度和力矩曲线。对比分析4个实验组与对照组的数据，相似性越高，证明手术疗效越好。 2.1 不同模型中手术节段(L3-L4)起止运动角度比较将实验组在手术节段(L3-L4)起止运动角度与正常状态的起止运动角度进行比较(图4)。在6种运动中，左右侧弯的运动幅度>前屈后伸的运动幅度>左右旋转的运动幅度。在屈伸运动中，后伸的运动幅度小于前屈的运动幅度。在5个实验组中，B组切除了L3-L4棘间和棘上韧带约束，运动幅度明显增大，脊柱稳定性损失较大；E组采用融合固定方式，限制了L3-L4的相对运动，因此运动幅度明显减小，稳定性增大了，但灵活性损失较大。总的来看，C组、D组与A组间差异较小；B组、E组与A组差异较大。在腰椎稳定方式中，Coflex固定组与完整对照组的运动性能最接近，腰椎融合固定组性能与完整对照组的运动性能相差较远。对于前屈后伸、左右侧弯和左右旋转这3类运动而言，Coflex固定组与融合固定组的运动角度相比分别为4.58、1.34和1.99倍。由此可见，前屈后伸受到稳定方式影响最大。 2.2 腰椎整体运动范围与所对应时刻力矩传感器输出端的力矩将三维运动系统(Raptor 4)记录的腰椎整体运动范围与所对应时刻力矩传感器输出端的力矩进行对应分析。如图5所示为A组腰椎整体运动角度随力偶矩变化趋势，其中X轴为角度变化，Y轴为力矩变化。在6种运动中，前屈和后伸、左侧弯和右侧弯、左旋和右旋几乎都是对称的。图6记录了腰椎L4的运动轨迹；可以看出腰椎L4实际的运动轨迹并不是圆弧运动。其他模型的相关参数分布趋势与图5、图6类似，故省略。"

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