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Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis – Lumbar Fusion

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The article explores the biomechanical effects of lumbar fusion on adjacent segments and the potential impact on adjacent segment degeneration (ASD). By using a finite element model, the study compares the range of motion (ROM), intradiscal pressure (IDP), and facet joint force (FJF) in intact and lumbar fusion models. The results show an increase in ROM, IDP, and FJF in adjacent segments following fusion, but by determining a relative total lumbar ROM, a decrease in these biomechanical parameters can be achieved. This suggests that postoperative activities within specific ROM ranges can help offset the increased pressure and force on adjacent segments, potentially alleviating ASD

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spine clinic in UK

Published article

S: The relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.

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BMC Musculoskelet Disord. 2024 Mar 5;25(1):197. doi: 10.1186/s12891-024-07322-3.ABSTRACTBACKGROUND: A reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an,

BMC Musculoskeletal Disord. 2024 Mar 5;25(1):197. doi: 10.1186/s12891-024-07322-3.

ABSTRACT

BACKGROUND: A reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an ideal adjacent segment ROM to guide postoperative waist activities and further delay adjacent segment degeneration (ASD).

METHODS: An intact L1-S1 finite element model was constructed and validated. Based on this, a surgical model was created to allow the simulation of L4/5 transforaminal lumbar interbody fusion (TLIF). Under the maximum total L1-S1 ROM, the ROM, IDP, and FJF of each adjacent segment between the intact and TLIF models were compared to explore the biomechanical influence of lumbar fusion on adjacent segments. Subsequently, the functional relationship between total L1-S1 ROM and IDP or total L1-S1 ROM and FJF was fitted in the TLIF model to calculate the relative total L1-S1 ROMs without an increase in IDP and FJF.

RESULTS: Compared with those of the intact model, the ROM, IDP, and FJF of the adjacent segments in the TLIF model increased by 12.6-28.9%, 0.1-6.8%, and 0-134.2%, respectively. As the total L1-S1 ROM increased, the IDP and FJF of each adjacent segment increased by varying degrees. The relative total L1-S1 ROMs in the TLIF model were 11.03°, 12.50°, 12.14°, and 9.82° in flexion, extension, lateral bending, and axial rotation, respectively.

S: The relative total L1-S1 ROMs after TLIF were determined, which decreased by 19.6-29.3% compared to the preoperative ones. Guiding the patients to perform postoperative waist activities within these specific ROMs, an increase in the IDP and FJF of adjacent segments may be effectively offset, thereby alleviating ASD.

PMID:38443904 | PMC:PMC10913564 | DOI:10.1186/s12891-024-07322-3

The London Spine Unit : most experienced spine clinic in UK

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Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis

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BMC Musculoskelet Disord. 2024 Mar 5;25(1):197. doi: 10.1186/s12891-024-07322-3.ABSTRACTBACKGROUND: A reduction in total lumbar range of motion (ROM) after lumbar fusion may offset the increase in intradiscal pressure (IDP) and facet joint force (FJF) caused by the abnormally increased ROM at adjacent segments. This study aimed to determine a relative total lumbar ROM rather than an

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