Application of an interspinous process device after minimally invasive lumbar decompression could lead to stress redistribution at the pars interarticularis: a finite element analysis

BMC Musculoskeletal Disorders

Sai-Wei Yang¹  Hao-Ju Lo²  Chen-Sheng Chen³  Hung-Ming Chen⁴ 

[1] 0000 0001 0425 5914, grid.260770.4, Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan;0000 0001 0425 5914, grid.260770.4, Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan;Department of Orthopedic Surgery, Dali Branch, Jen-Ai Hospital, 483 Dong Rong Rd, Dali, Taichung, Taiwan;0000 0001 0425 5914, grid.260770.4, Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No.155, Sec.2, Linong Street, 11221, Taipei, Taiwan;Department of Orthopedic Surgery, Renai Branch, Taipei City Hospital, No. 10, Section 4, Ren’ai Road, Da’an District, 106, Taipei City, Taiwan;

关键词: Interspinous process device;    Minimally invasive;    Finite element model;    Pars interarticularis;   

DOI  :  10.1186/s12891-019-2565-5

来源: publisher

【 摘 要 】

BackgroundAn interspinous process device, the Device for Intervertebral Assisted Motion (DIAM™) designed to treat lumbar neurogenic disease secondary to the lumbar spinal stenosis, it provides dynamic stabilization after minimally invasive (MI) lumbar decompression. The current study was conducted using an experimentally validated L1-L5 spinal finite element model (FEM) to evaluate the limited decompression on range of motion (ROM) and stress distribution on a neural arch implanted with the DIAM.MethodsThe study simulated bilateral laminotomies with partial discectomy at L3-L4, as well as unilateral and bilateral laminotomies with partial discectomy combined with implementation of the DIAM at L3-L4. The ROM and maximum von Mises stresses in flexion, extension, lateral bending, and axial torsion were analyzed in response to the hybrid protocol in comparison with the intact model.ResultsThe investigation revealed that decreased ROM, intradiscal stress, and facet joint force at the implant level, but considerably increased stress at the pars interarticularis were found during flexion and torsion at the L4, as well as during extension, lateral bending, and torsion at the L3, when the DIAM was implanted compared with the defect model.ConclusionThe results demonstrate that the DIAM may be beneficial in reducing the symptoms of stress-induced low back pain. Nevertheless, the results also suggest that a surgeon should be cognizant of the stress redistribution at the pars interarticularis results from MI decompression plus the application of the interspinous process device.

【 授权许可】

CC BY