A new laser scanning technique for imaging intervertebral disc displacement and its application to modeling nucleotomy.
BACKGROUND
Nucleotomy is a standard procedure for treating disc prolapse. It can reduce intervertebral disc height, flattening and displacing the disc, which could lead to a painful narrowing of the foramina due to nerve root compression. The purpose of this study was to investigate the disc displacement of a complete spinal segment with and without nucleotomy. We hypothesized that a nucleotomy under a certain load combination might amplify disc displacement.


METHODS
A laser scanner was developed for recording three-dimensional disc displacement of six loaded L4-5 specimens for three conditions: intact, disc with vertebral bodies and subsequent nucleotomy. Specimens were exposed to pure moments of 7.5 N m in the three principal anatomical directions. Disc displacement was obtained at maximal deflection. A finite element model was validated and subsequently utilized to determine disc displacement. The task of the finite element model was to provide supplemental data for the posterolateral region, which could not be measured from intact specimens.


RESULTS
Disc displacement measurements of intact specimens were limited to the anterior part of discs, whereas the finite element model was able to provide the missing data of the dorsal disc region. The simulation of load combinations showed that the highest disc displacement was 1.9 mm at the lateral or posterolateral region. The nucleotomy increased the disc displacement up to 2.1mm, whereas the displacement zenith migrated posterolaterally.


CONCLUSIONS
These results could be a possible explanation for disadvantages of nucleotomy as a treatment. With the methodology presented here, we would be able to assess the performance of nucleus implants by determining the disc displacement map. This could also give us appropriate information of the annular deformation, which is needed for the development of motion preserving implants.
Heuer
Frank
F
Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstr. 14, 89081 Ulm, Germany.
Schmidt
Hendrik
H
Claes
Lutz
L
Wilke
Hans-Joachim
HJ
D003198:Computer Simulation; D017587:Diskectomy, Percutaneous / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D066298:In Vitro Techniques; D007403:Intervertebral Disc / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000601:surgery*; D007834:Lasers; D008875:Middle Aged; D008954:Models, Biological; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*