![]() Further, we aimed to elaborate on the biomechanical characteristics of two ligamentous vertebral stabilization techniques usable after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures).įull size table Description of the stepwise surgical decompression and techniques of vertebropexy Microsurgical decompression and interspinous vertebropexyĪ bilateral approach was used with sparing laminotomy of the overlying and underlying lamina. Therefore, we inquired if such ligamentous fixation of the vertebra, would be feasible in the lumbar spine. Ī promising concept that utilizes the orthopedic principles of ligament reinforcement for joint stabilization has already been successfully applied to the treatment of dropped head syndrome, resulting in a fusion-free stabilization of the head. Semi-rigid fixation techniques have been proposed to overcome the above-mentioned challenges, but resulted in new complications at the implant–bone interface, such as device breakage, dislocation or screw loosening. Īlthough these challenges are well-known, alternative techniques of spinal stabilizations have not yet yielded satisfactory results with broad clinical impact. Further, long fusions can lead to a relevant, irreversible loss of motion, which can cause postural changes. The redistribution of loads with subsequently increased biomechanical stress are believed to act as accelerators of ASD and proximal junctional kyphosis. However, spinal fusion is associated with serious long-term complications, such as adjacent segment degeneration (ASD), screw loosening, pseudoarthrosis, implant failure, and, in rare cases, neurovascular injury during implant insertion. The latter can also be a result of iatrogenic destabilization following surgical resection of ligamentous structures as well as the facet joint. The indications for this surgical procedure are diverse and include low-back pain due to facet joint osteoarthritis, degenerative spondylolisthesis, degenerative scoliosis and segmental instability. Spinal fusion has become a very common surgical procedure, among others in the treatment of degenerative disorders of the spine. Studies are needed to evaluate its clinical application. It is able to reduce motion, especially in flexion–extension. Vertebropexy is a new concept of semi-rigid spinal stabilization based on ligamentous reinforcement of the spinal segment. Both techniques were able to reduce vertebral body segment ROM in FE, LS and LB beyond the native state. Vertebral segment ROM was significantly smaller with the interspinous vertebropexy compared to the interlaminar vertebropexy for all loading scenarios except FE. Interspinous vertebropexy significantly reduced the range of motion (ROM) in all loading scenarios compared to microsurgical decompression: in FE by 70% ( p < 0.001), in LS by 22% ( p < 0.001), in LB by 8% ( p < 0.001) in AS by 12% ( p < 0.01) and in AR by 9% ( p < 0.001). In the intact state and after every surgical step, the segments were loaded in flexion–extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR). The specimens were tested (1) in the native state, after (2) microsurgical decompression, (3) interspinous vertebropexy, (4) midline decompression, and (5) interlaminar vertebropexy. Stabilization was achieved with a gracilis or semitendinosus tendon allograft, which was attached to the spinous process (interspinous vertebropexy) or the laminae (interlaminar vertebropexy) in form of a loop. Methodsįifteen spinal segments were biomechanically tested in a stepwise surgical decompression and ligamentous stabilization study. To develop ligamentous vertebral stabilization techniques (“vertebropexy”) that can be used after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures) and to elaborate their biomechanical characteristics.
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