title: Intradiscal pressure measurements above an instrumented fusion. A cadaveric study.
abstract: METHODS
  An in vitro study to determine the intradiscal pressure changes during flexion in levels above a simulated fusion was performed.
  
  
  OBJECTIVE
  To determine if intradiscal pressure increases more during flexion in discs above an instrumented spinal segment compared to an uninstrumented segment.
  
  
  BACKGROUND
  The progressive degeneration of intervertebral discs adjacent to a fused or fixed segment is a phenomenon that is noted but poorly understood. Intuitively, the degeneration appears to be a function of altered biomechanics of the motion segments in the spine.
  
  
  METHODS
  Two intervertebral disc levels were evaluated, L3-L4 and L4-L5 from each of six fresh frozen cadaver spines. Pressure measurements were taken with the spine uninstrumented, with bilateral pedicle screw-rod instrumentation from L5 to S1, and with bilateral pedicle screw-rod instrumentation from L4 to S1. Pressure measurements were accomplished with Millar Mikro-Tip pressure transducers. The transducers were placed within the nucleus pulposus of L3-L4 and L4-L5 intervertebral discs. Pressure data were recorded by computer data acquisition. The pressure data were compared by intervertebral level and by the effects of added instrumentation.
  
  
  RESULTS
  In general, the addition of instrumentation significantly affected the intradiscal pressure in the levels above a simulated fusion. The intradiscal pressure increased as the amount of levels involved in the simulated fusion increased. The intradiscal pressure increased as flexion motion increased. A greater increase was seen at the L4-L5 level than the L3-L4 level. When L5-S1 fixation was added, the intradiscal pressure increased. When L4-S1 fixation was added, the intradiscal pressure further increased.
  
  
  CONCLUSIONS
  This study demonstrated increasing intradiscal pressures during flexion.
authors.affiliation: Texas Back Institute Research Foundation, Plano, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Weinhoffer
authors.forename: R D
authors.initials: RD
authors.lastname: Guyer
authors.forename: M
authors.initials: M
authors.lastname: Herbert
authors.forename: S L
authors.initials: SL
authors.lastname: Griffith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007403:Intervertebral Disc / Q000502:physiology*; D008875:Middle Aged; D011312:Pressure; D013123:Spinal Fusion