Biomechanical and radiographic analysis of a novel, minimally invasive, extension-limiting device for the lumbar spine.
OBJECTIVE
Biomechanical testing and fluoroscopic imaging were used to study an extension-limiting device that has been developed to support and cushion the facet complex. It is a titanium screw-based system with a polycarbonate-urethane bumper that lies against the inferior articular process and is anchored into the pedicle by the screw for posterior dynamic stabilization (PDS).


METHODS
Six human cadaveric spines were dissected from L-2 to L-5, leaving all ligamentous structures intact. The intact spines were first tested in flexion and extension, lateral bending, and axial rotation at 67.5 Nm. The PDS devices were inserted at L3-4 and testing was repeated. Fluoroscopic analysis of posterior disc height and foraminal area of the intact and instrumented spines while loaded was performed. All test data were compared using a one-way analysis of variance (statistical significance was set at p < 0.05). Instrumented spines had 62% less motion during flexion and 49% less motion during extension compared with the intact spines. Neuroimaging analysis showed 84% less compression of the posterior disc of the instrumented spines during extension, and no difference during flexion compared with intact spines. After instrumentation was affixed, the foraminal area was 36% larger than in intact spines during extension and 9% larger during flexion. During axial loading, compression of the posterior disc was decreased by 70%, and analysis showed 10% decompression prior to loading just from implanting the devices.


CONCLUSIONS
The PDS system has the benefit of being a completely percutaneous one, which can be used at all levels of the lumbar spine, including S-1. The PDS system limits spinal motion, enlarges the foramina, and achieves discal decompression.
Palmer
Sylvain
S
Mission Hospital and Regional Medical Center, University of California, Irvine, California, USA. sylvainpalmer@cox.net
Mahar
Andrew
A
Oka
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D019245:Compressive Strength / Q000502:physiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007403:Intervertebral Disc / Q000502:physiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D009068:Movement; D019736:Prostheses and Implants; D013123:Spinal Fusion / Q000295:instrumentation*; D013128:Spinal Osteophytosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016474:Weight-Bearing / Q000502:physiology*