Results of multilevel posterior ligament dissection after spinal instrumentation on adjoining section biomechanics as a possible danger issue for proximal junctional kyphosis: a biomechanical research.

Articles

BMC Musculoskelet Disord. 2018 Feb 14;19(1):57

Authors: Lange T, Schulte TL, Gosheger G, Schulze Boevingloh A, Mayr R, Schmoelz W

Summary
BACKGROUND: Spinous processes and posterior ligaments, comparable to inter- and supraspinous ligaments are sometimes sacrificed both intentionally to reap osseous materials for closing spondylodesis e.g. in deformity corrective surgical procedure or unintentionally after posterior spinal instrumentation. This biomechanical research evaluates the potential destabilizing impact of a progressive dissection of the posterior ligaments (PL) after instrumented spinal fusion as a possible danger issue for proximal junctional kyphosis (PJK).
METHODS: Twelve calf lumbar spines have been instrumented from L3 to L6 (L3?=?higher instrumented vertebra, UIV) and randomly assigned to one of many two research teams (dissection vs. management group). The specimens within the dissection group underwent progressive PL dissection, adopted by cyclic flexion movement (250 cycles, second: +?2.5 to +?20.zero Nm) to simulate bodily exercise and vary of movement (ROM) testing of every section with pure moments of ±15.zero Nm after every dissection step. The segmental ROM in flexion and extension was measured. The management group underwent the identical loading and ROM testing protocol, however with out PL dissection.
RESULTS: Within the remedy group, the normalized imply ROM at L2-L3 (direct adjoining section of curiosity, UIV/UIV?+?1, PJK-level) elevated to 104.7%, 107.three%, and 119.four% after dissection of the PL L4-L6, L3-L6, and L2-L6, respectively. Within the management group the imply ROM elevated solely to 103.2%, 106.7%, and 108.7%. The ROM distinction at L2-L3 with regard to the final dissection of the PL was statistically vital (P?=?zero.017) and a PL dissection within the instrumented segments confirmed a optimistic pattern in the direction of an elevated ROM at UIV/UIV?+?1.
CONCLUSIONS: A dissection of the PL at UIV/UIV?+?1 results in a major improve in ROM at this stage which may be thought-about to be a danger issue for PJK and needs to be undoubtedly prevented throughout surgical procedure. Nevertheless, a dissection of the posterior ligaments inside the instrumented segments whereas preserving the ligaments at UIV/UIV?+?1 results in a slight however not vital improve in ROM within the adjoining cranial section UIV/UIV?+?1 within the used experimental setup. Utilizing this experimental setup we couldn’t verify our preliminary speculation that the posterior ligaments inside an extended posterior instrumentation needs to be preserved.

PMID: 29444669 [PubMed – in process]

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