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      Biomechanical effect of bone resorption of the spinous process after single-segment interspinous dynamic stabilization device implantation : A finite element analysis

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          Abstract

          This study aims to explore the influence of bone resorption of the spinous process after single-segment interspinous process device (IPD) implantation on the biomechanics of the lumbar spine.

          The 3D finite element model of the lumbar spine (L3-L5) was modified, and 2 models that simulated the presence and absence of bone resorption of the spinous process were developed using an IPD (Wallis). Its biomechanical effects, such as change in range of motion (ROM) and intervertebral disc and facet stress, were introduced at operative (L4/5) and adjacent (L3/4) levels.

          Compared with the INT model, the Wallis model and Wallis-BR model had similar ROMs in lateral flexion and rotation. However, the Wallis model had a lower L3–5 ROM in flexion (20.4% lower) and extension (26.4% lower), and L4-L5 ROM in flexion (74.1% lower) and extension (70.8% lower), while the overall ROM of the Wallis-BR model was greater than that of the Wallis model. The stress on the L3/L4 intervertebral disc and facets was similar for all 3 models. Compared with the INT model and Wallis-BR model, the stress on the L4/L5 intervertebral disc and facets under all movements significantly decreased in the Wallis model. The stress on the L5 process was greater than that on the L4 process in both the Wallis model and Wallis-BR model, and the load on the processes that underwent bone resorption was lower than that of the Wallis model.

          The function of the IPD slowly decreased with the occurrence of bone resorption of the interspinous process. This bone remodeling may be associated with high stress after IPD implantation.

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          Most cited references31

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          Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.

          Elizabeth Friis, Jens Ivar Brox, Oystein P. Nygaard … (2003)
          Single blind randomized study. To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%. The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion.
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            Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases With a Minimum of 10 Years of Follow-up.

            Hiroaki Nakashima, Noriaki Kawakami, Taichi Tsuji … (2015)
            Retrospective case-controlled study.
            Article 0 comments Cited 58 times – based on 0 reviews     Review now
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              Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis.

              Mark Orr, L. Nolte, Lutz P Nolte … (2003)
              Intervertebral cages in the lumbar spine have been an advancement in spinal fusion to relieve low back pain. Even though initial stability is accepted as a requirement for fusion, there are other factors. The load transfer and its effect on the tissues adjacent to the cage may also play an essential role, which is not easily detectable with experimental tests. In this study the effects of an intervertebral cage insertion on a lumbar functional spinal unit were investigated using finite element analyses. The influences of cage material, cancellous bone density and spinal loading for the stresses in a functional spinal unit were evaluated. Three-dimensional (3D) finite element models of L2-L3 were developed for this purpose. An anterior approach for a monobloc, box-shaped cage was modelled. Models with cage were compared to the corresponding intact ones. The results showed that inserting a cage increased the maximum von Mises stress and changed the load transfer in the adjacent structures. Varying the cage material or the loading conditions had a much smaller influence than varying the cancellous bone density. The denser the cancellous bone, the more the stress was concentrated underneath the cage, while the remaining regions were unloaded. This study showed that the density of the underlying cancellous bone is a more important factor for the biomechanical behaviour of a motion segment stabilized with a cage, and its eventual clinical success, than the cage material or the applied load. Inserting an intervertebral cage markedly changed the load transfer. The altered stress distribution may trigger bone remodelling and explain damage of the underlying vertebrae.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: July 2018
                Publication date (Electronic): 06 July 2018
                Volume: 97
                Issue: 27
                Electronic Location Identifier: e11140
                Affiliations
                Spine Surgery of Peking University People's Hospital, Beijing, China.
                Author notes
                [∗ ]Correspondence: Kai-Feng Wang, Spine Surgery of Peking University People's Hospital, No. 11 of Xizhimen South Street, Xicheng District, Beijing 100044, China (e-mail: wang3092@ 12345621cn.com ).
                Article
                Publisher ID: MD-D-17-06044 Accession ID: 11140
                DOI: 10.1097/MD.0000000000011140
                PMC ID: 6076163
                PubMed ID: 29979380
                SO-VID: 0235ecd7-2f37-416e-91c8-052c9a1a1a3a
                Copyright © Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                Date received : 29 September 2017
                Date accepted : 24 May 2018
                Categories
                Subject: 7100
                Subject: Research Article
                Subject: Observational Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: finite element,interspinous dynamic stabilization device,spinous process bone resorption,wallis system
                Data availability:
                Keywords: finite element, interspinous dynamic stabilization device, spinous process bone resorption, wallis system

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