Skip to main content Accessibility help
×
Home

Radiological and Mathematical Studies Regarding the Effects of Spinal Fixation on Kinematics and Mechanics at the Parafixed Segments

  • S.-C. Lin (a1), W.-C. Tsai (a2), S.-S. Wu (a2) and P.-Q. Chen (a3) (a4)

Abstract

Spinal fixation and fusion has been adopted as a common procedure in spinal surgery. However, the degeneration as a result of parafixation may produce clinically significant problems. Previous studies have already shown increased loads, mobility, and intradiscal pressure at the parafixed segments. These may hasten the degeneration and instability of the neighboring segments. However, controversy remains regarding the correlation between surgical fixation and degeneration owing to parafixation. This study tried to elucidate their relationship by analyzing the in vivo roentgenograms of the post-fusion lumbar spine to measure the motion distribution of the fixed and adjacent unfused spinal segments. In addition, a mathematical model was developed to investigate the effects of implant fixation on the kinematics and mechanics at the parafixation segments.

The current radiological studies demonstrated that spinal fixation resulted in the redistribution of intersegmental mobility. The loss of flexion mobility at the fixed segments was unequally compensated for by the increased mobility at all adjacent free segments. This mechanical model can predict the redistribution patterns of mobility and stress at the parafixation segments. This redistribution depends on the fixation levels, implant rigidity, and subject predisposition. Additionally, such compensation was more marked in the tri-segmental than in the two-segment fixation, especially among patients who underwent greater spinal load.

This study concluded that the increased flexural rigidity at the fixed segment leads to the compensated kinematic and mechanical demands upon the unfixed adjacent segments. Accordingly, the cumulative effects of such increased mobility and loadings on the adjacent segments could be logically postulated to be the principal causes of accelerated degeneration of the adjacent lumbar segments, both upper and lower portions, subsequent to fusion surgery.

Copyright

Corresponding author

*Ph.D.
**M.D.
***Ph.D., M.D., corresponding author

References

Hide All
1.Ishihara, H., Osada, R., Kanamori, M., Kawaguchi, Y., Ohmori, K., Kimura, T., Matsu, H. and Tsuji, H., “Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Isthmic Spondylolisthesis,” Journal of Spinal Disorders & Techniques, 14, pp. 9199 (2001).
2.Yang, J. Y., Lee, J. K. and Song, H. S., “The Impact of Adjacent Segment Degeneration on the Clinical Outcome after Lumbar Spinal Fusion,” Spine, 33, pp. 503507 (2008).
3.Schulte, T. L., Leistra, F., Bullmann, V., Osada, N., Vieth, V., Marquardt, B., Lerner, T., Liljenqvist, U. and Hackenberg, L., “Disc Height Reduction in Adjacent Segments and Clinical Outcome 10 Years after Lumbar 360 Degrees Fusion,” European Spine Journal, 16, pp. 21522158 (2007).
4.Kwon, B. K., Elgafy, H., Keynan, O., Fisher, C. G., Boyd, M. C, Paquette, S. J. and Dvorak, M. F., “Progressive Junctional Kyphosis at the Caudal End of Lumbar Instrumented Fusion: Etiology, Predictors, and Treatment,” Spine, 31, pp. 19431951 (2006).
5.Etebar, S. and Cahill, D. W., “Risk Factors for Adjacent-Segment Failure Following Lumbar Fixation with Rigid Instrumentation for Degenerative Instability,” Journal of Neurosurgery, 90, pp. 163169 (1999).
6.Goffin, J., van Loon, J., Van Calenbergh, F. and Plets, C, “Long-Term Results after Anterior Cervical Fusion and Osteosynthetic Stabilization for Fractures and/or Dislocations of the Cervical Spine,” Journal of Spinal Disorders & Techniques, 8, pp. 500508 (1995).
7.Hoogendoorn, R. J., Helder, M. N., Wuisman, P. I., Bank, R A., Everts, V. E. and Smit, T. H., “Adjacent Segment Degeneration: Observations in a Goat Spinal Fusion Study,” Spine, 33, pp. 13371343 (2008).
8.Hayashi, T., Arizono, T., Fujimoto, T., Moro-oka, T., Shida, J., Fukumoto, S. and Masuda, S., “Degenerative Change in the Adjacent Segments to the Fusion Site after Posterolateral Lumbar Fusion with Pedicle Screw Instrumentation—A Minimum 4-year Follow-up,” HukuokaActaMedica, 13, pp. 107113 (2008).
9.Nakai, S., Yoshizawa, H. and Kobayashi, S., “Long-term Follow-up Study of Posterior Lumbar Interbody Fusion,” Journal of Spinal Disorders & Techniques, 12, pp. 293299 (1999).
10.Natarajan, R. N., Andersson, G. B., Patwardhan, A. G. and Andriacchi, T. P., “Study on Effect of Graded Facetectomy on Change in Lumbar Motion Segment Torsional Flexibility using Three-dimensional Continuum Contact Representation for Facet Joints,” Journal of Biomechanical Engineering, 121, pp. 215221 (1999).
11.Schulitz, K. P., Assheuer, J. and Wehling, P., “Degeneration in the adjacent level above lumbar fusion,” Proceedings of International Society for the Study of the Lumbar Spine, p. 216 (1994).
12.Wimmer, C, Gluch, H., Krismer, M., Ogon, M. and Jesenko, R., “AP-Translation in the Proximal Disc Adjacent to Lumbar Spine Fusion: A Retrospective Comparison of Mono- and Polysegmental Fusion in 120 Patients,” Acta Orthopaedica Scandinavica, 68, pp. 269272 (1997).
13.Yoganandan, N., Pintar, F. and Maiman, D. J., “Kinematics of the Lumbar Spine Following Pedicle Screw Plate Fusion,” Spine, 18, pp. 504512 (1993).
14.Chow, D. H., Luk, K. D., Evans, J. H. and Leong, J. C, “Effects of Short Anterior Lumbar Interbody Fusion on Biomechanics of Neighboring Unfused Segments,” Spine, 21, pp. 549555 (1996).
15.Wimmer, C, Gluch, H., Krismer, M., Ogon, M. and Jesenko, R., “AP-Translation in the Proximal Disc Adjacent to Lumbar Spine Fusion: A Retrospective Comparison of Mono- and Polysegmental Fusion in 120 Patients,” Acta Orthopaedica Scandinavica, 68, pp. 269272 (1997).
16.Hilibrand, A. S., Carlson, G. D., Palumbo, M. A., Jones, P. K. and Bohlman, H. H., “Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis,” The Journal of Bone and Joint Surgery, 84–A, pp. 519528 (1999).
17.Dvorak, J., Panjabi, M. M., Novotny, J. E., Chang, D. G. and Grob, D., “Clinical Validation of Functional Flexion-extension Roentgenograms of the Lumbar Spine,” Spine, 16, pp. 943950 (1991).
18.Lin, R M., Yu, C. Y., Chang, Z. J., Lee, C. C. and Su, F. C, “Flexion-extension Rhythm in the Lumbosacral Spine,” Spine, 19, pp. 22042209 (1994).
19.Miyasaka, K., Kazuo, O., Suzuki, K. and Inoue, H., “Radiographic Analysis of Lumbar Motion in Relation to Lumbosacral Stability,” Spine, 25, pp. 732737 (2000).
20.Putto, E. and Tallroth, K., “Extension-flexion Radiographs for Motion Sstudies of the Lumbar Spine: A Comparison of Two Methods,” Spine, 15, pp. 107110 (1990).
21.Shono, Y., Kaneda, K., Abumi, K., McAfee, P. C. and Cunningham, B. W., “Stability of Posterior Spinal Instrumentation and its Effects on Adjacent Motion Segments in the Lumbosacral Spine,” Spine, 23, pp. 15501558 (1998).
22.Johnsson, R., Axelsson, P., Gunnarsson, G. and Stromqvist, B., “Stability of Lumbar Fusion with Transpedicular Fixation Determined by Roentgen Stereophotogrammetric Analysis,” Spine, 24, pp. 687690 (1999).
23.Rohlmann, A., Calisse, J., Bergmann, G. and Weber, U., “Internal Spinal Fixator Stiffness has Only a Minor Influence on Stresses in the Adjacent Discs,” Spine, 24, pp. 11921196 (1999).
24.Gilad, I. and Nissan, M., “A Study of Vertebra and Disc Geometric Relations of the Human Cervical and Lumbar Spine,” Spine, 11, pp. 154157 (1986).
25.Guyer, D. W., Yuan, H. A., Werner, F. W., Frederickson, B. E. and Murphy, D., “Biomechanical Comparison of Seven Internal Fixation Devices for the Lumbosacral Junction,” Spine, 12, pp. 569573 (1987).
26.Cunningham, B. W., Kotani, Y., McNulty, P. S., Cappuccino, A. and McAfee, P. C, “The Effect of Spinal Destabilization and Instrumentation on Lumbar Intradiscal Pressure: An in vitro Biomechanical Analysis,” Spine, 22, pp. 26552663 (1997).
27.Schlegel, J. D., Smith, J. A. and Schleusener, R. L., “Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions,” Spine, 21, pp. 970981 (1996).
28.Pihlajamaki, H., Myllynen, . and Bostman, O., “Complications of Transpedicular Lumbosacral Fixation for Non-traumatic Disorders,” The Journal of Bone and Joint Surgery, 79–B, pp. 183189 (1997).
29.Hsu, K. Y., Zucherman, J., White, A., Reynolds, J. and Goldthwaite, N, “Deterioration of Motion Segments Adjacent to Lumbar Spine Fusion,” Annual Meeting of the North American Spine Society, Colorado Spring, Colorado, pp. 24–27 (1988).
30.Louis, R., “Fusion of the Lumbar and Sacral Spine by Internal Fixation with Screw Plates,” Clinical Orthopaedics and Related Research, 203, pp. 1833 (1986).
31.Lehmann, T. R., Spratt, K. F., Tozzi, J. E., Weinstein, J. N., Reinarz, S. J., El-Khoury, G. Y. and Colby, H., “Long-term Follow-up of Lumbar Fusion Patients,” Spine, 12, pp. 97104 (1987).
32.El-Bohy, A. A., Yang, K. H. and King, A. I., “Experimental Verification of Facet Load Transmission by Direct Measurement of Facet Lamina Contact Pressure,” Journal of Biomechanical Engineering, 22, pp. 931941 (1998).
33.Anderson, C. K., Chaffin, D. B. and Herrin, G. D., “A Study of Lumbosacral Orientation under Varied Static Loads,” Spine, 11, pp. 456462 (1986).

Keywords

Radiological and Mathematical Studies Regarding the Effects of Spinal Fixation on Kinematics and Mechanics at the Parafixed Segments

  • S.-C. Lin (a1), W.-C. Tsai (a2), S.-S. Wu (a2) and P.-Q. Chen (a3) (a4)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed