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Article: Stability of the whole lumbar spine after multilevel fenestration and discectomy

TitleStability of the whole lumbar spine after multilevel fenestration and discectomy
Authors
Issue Date1999
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 1999, v. 24 n. 13, p. 1277-1282 How to Cite?
AbstractStudy Design. An investigation of the in vitro biomechanical effects of multilevel fenestrations and discectomies on the behavior of whole lumbar spine motion, using a material testing system (Instron 1341, Instron Limited, High Wycombe, England) and Elite three-dimensional motion analysis system (BTS, Milano, Italy). Objectives. To investigate the effects of multilevel fenestrations and discectomies on the stability of the whole lumbar spine, including segmental stiffness and sagittal (horizontal and vertical) translation. Summary of Background Data. In the management of lumbar spinal stenosis, wide decompressive laminectomy with partial or total facetectomy has been the standard procedure for multilevel nerve decompression. Main complications with these procedures have been instability and chronic pain syndrome. Multilevel fenestration with undermining enlargement of the spinal canal has been selected for multilevel nerve decompression in recent years. However, the biomechanical effects of multilevel fenestration and discectomy have been controversial and difficult to validate. This study investigated the in vitro biomechanical effects of multilevel fenestrations and discectomies on motion behavior of the whole lumbar spine. Methods. Seven fresh human specimens from L1 to sacrum were used in this study. The fenestrations and discectomies consisted of L3-L4 bilateral fenestration, L4- L5 bilateral fenestration, L5-S1 bilateral fenestration, L4-L5 discectomy, and L5-S1 discectomy. Flexion, lateral bending, and axial rotation (torsion) loading were applied. Ranges of motion were determined two-dimensionally by the Elite system with an infrared camera. The postoperation results were compared with the intact conditions. Results. After multiple fenestrations, the sagittal ranges of motion at L4-L5 increased by 18% anteroposteriorly and 16% vertically under the flexion loads. At L5-S1, the motions increased by 19% and 45%, respectively. After fenestrations and discectomies, the ranges of motion in the sagittal plane increased by 25% horizontally and 71% vertically at L4-L5, and 14% and 166% at L5-S1. Motion increases were statistically significant (P < 0.05) in vertical translations. However, after the multilevel surgeries, no significant motions were found in each of the lumbar segments during lateral bending and axial rotation. Conclusions. The results demonstrate that multilevel fenestrations and discectomies affect lumbar spinal stability in flexion, but have no effect on the stability of the lumbar spine in lateral bending or axial rotation.
Persistent Identifierhttp://hdl.handle.net/10722/170020
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLu, WWen_US
dc.contributor.authorLuk, KDKen_US
dc.contributor.authorRuan, DKen_US
dc.contributor.authorFei, ZQen_US
dc.contributor.authorLeong, JCYen_US
dc.date.accessioned2012-10-30T06:04:48Z-
dc.date.available2012-10-30T06:04:48Z-
dc.date.issued1999en_US
dc.identifier.citationSpine, 1999, v. 24 n. 13, p. 1277-1282en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/170020-
dc.description.abstractStudy Design. An investigation of the in vitro biomechanical effects of multilevel fenestrations and discectomies on the behavior of whole lumbar spine motion, using a material testing system (Instron 1341, Instron Limited, High Wycombe, England) and Elite three-dimensional motion analysis system (BTS, Milano, Italy). Objectives. To investigate the effects of multilevel fenestrations and discectomies on the stability of the whole lumbar spine, including segmental stiffness and sagittal (horizontal and vertical) translation. Summary of Background Data. In the management of lumbar spinal stenosis, wide decompressive laminectomy with partial or total facetectomy has been the standard procedure for multilevel nerve decompression. Main complications with these procedures have been instability and chronic pain syndrome. Multilevel fenestration with undermining enlargement of the spinal canal has been selected for multilevel nerve decompression in recent years. However, the biomechanical effects of multilevel fenestration and discectomy have been controversial and difficult to validate. This study investigated the in vitro biomechanical effects of multilevel fenestrations and discectomies on motion behavior of the whole lumbar spine. Methods. Seven fresh human specimens from L1 to sacrum were used in this study. The fenestrations and discectomies consisted of L3-L4 bilateral fenestration, L4- L5 bilateral fenestration, L5-S1 bilateral fenestration, L4-L5 discectomy, and L5-S1 discectomy. Flexion, lateral bending, and axial rotation (torsion) loading were applied. Ranges of motion were determined two-dimensionally by the Elite system with an infrared camera. The postoperation results were compared with the intact conditions. Results. After multiple fenestrations, the sagittal ranges of motion at L4-L5 increased by 18% anteroposteriorly and 16% vertically under the flexion loads. At L5-S1, the motions increased by 19% and 45%, respectively. After fenestrations and discectomies, the ranges of motion in the sagittal plane increased by 25% horizontally and 71% vertically at L4-L5, and 14% and 166% at L5-S1. Motion increases were statistically significant (P < 0.05) in vertical translations. However, after the multilevel surgeries, no significant motions were found in each of the lumbar segments during lateral bending and axial rotation. Conclusions. The results demonstrate that multilevel fenestrations and discectomies affect lumbar spinal stability in flexion, but have no effect on the stability of the lumbar spine in lateral bending or axial rotation.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_US
dc.relation.ispartofSpineen_US
dc.subject.meshAdulten_US
dc.subject.meshBiomechanicsen_US
dc.subject.meshCadaveren_US
dc.subject.meshDiskectomyen_US
dc.subject.meshHumansen_US
dc.subject.meshInfrared Rays - Diagnostic Useen_US
dc.subject.meshLumbar Vertebrae - Physiology - Radiography - Surgeryen_US
dc.subject.meshRange Of Motion, Articular - Physiologyen_US
dc.subject.meshSpinal Fusionen_US
dc.subject.meshSpinal Stenosis - Surgeryen_US
dc.subject.meshVideo Recordingen_US
dc.titleStability of the whole lumbar spine after multilevel fenestration and discectomyen_US
dc.typeArticleen_US
dc.identifier.emailLu, WW:wwlu@hku.hken_US
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_US
dc.identifier.authorityLu, WW=rp00411en_US
dc.identifier.authorityLuk, KDK=rp00333en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/00007632-199907010-00002en_US
dc.identifier.pmid10404567-
dc.identifier.scopuseid_2-s2.0-0033169019en_US
dc.identifier.hkuros51974-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0033169019&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume24en_US
dc.identifier.issue13en_US
dc.identifier.spage1277en_US
dc.identifier.epage1282en_US
dc.identifier.isiWOS:000081171300001-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLu, WW=7404215221en_US
dc.identifier.scopusauthoridLuk, KDK=7201921573en_US
dc.identifier.scopusauthoridRuan, DK=7004456354en_US
dc.identifier.scopusauthoridFei, ZQ=36953803900en_US
dc.identifier.scopusauthoridLeong, JCY=35560782200en_US

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