Biomechanical analysis of the disc adjacent to posterolateral fusion with laminectomy in lumbar spine.
OBJECTIVE
After posterolateral fusion with laminectomy for the degenerative lumbar spine, accelerated degeneration of the disc adjacent to the fusion mass has been clinically observed. Previous studies used a finite element model (FEM) to calculate the stress of the adjacent disc in the fused lumbar spine with spinal fixator and bone graft. However, little emphasis was placed on the simultaneous spinal fusion and decompression procedure. To investigate if the spinal decompression procedure in posterolateral fusion would increase stress significantly, the FEM was employed to estimate the stress concentration of the disc above the fusion mass in posterolateral fusion with laminectomy and hemilaminectomy.


METHODS
Three FEMs of the lumbar spine were established: intact spine, posterolateral fusion with total laminectomy, and posterolateral fusion with hemilaminectomy (preserved partial lamina, spinous process, and supraspinous and interspinous ligaments). The posterolateral fusion added spinal fixator and bone graft between the transverse process. The L1 vertebral body was subjected to 10-Nm flexion, extension, torsion, and lateral bending. The bottom of the L5 vertebral body was fixed.


RESULTS
In flexion, the stress on the adjacent disc in posterolateral fusion with laminectomy and hemilaminectomy respectively increased 90% and 21% over that of the intact spine. In posterolateral fusion with hemilaminectomy, the supraspinous and interspinous ligaments shared some external forces to alleviate the stress concentration of the adjacent disc. However, in extension, torsion, and lateral bending, these two fusion models had almost no change in range of motion and stress of adjacent disc.


CONCLUSIONS
Posterolateral fusion with hemilaminectomy (preserved partial lamina, spinous process, and supraspinous and interspinous ligaments) was able to alleviate the stress concentration of the disc above the fusion mass in flexion.
Chen
Chen-Sheng
CS
Institute of Rehabilitation Science and Technology, National Yang-Ming University, 155 Sec. 2 Li-Nung Street, Taipei, Taiwan.
Feng
Chi-Kuang
CK
Cheng
Cheng-Kung
CK
Tzeng
Ming-Ji
MJ
Liu
Chien-Lin
CL
Chen
Wen-Jer
WJ
D001696:Biomechanical Phenomena; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000601:surgery*; D007796:Laminectomy / Q000592:standards*; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000601:surgery*; D008953:Models, Anatomic; D013123:Spinal Fusion / Q000592:standards*; D013718:Tensile Strength