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1.
Arno Bisschop Jaap H. van Dieën Idsart Kingma Albert J. van der Veen Timothy U. Jiya Margriet G. Mullender Cornelis P. L. Paul Marinus de Kleuver Barend J. van Royen 《European spine journal》2013,22(8):1785-1793
Purpose
Lumbar laminectomy affects spinal stability in shear loading. However, the effects of laminectomy on torsion biomechanics are unknown. The purpose of this study was to investigate the effect of laminectomy on torsion stiffness and torsion strength of lumbar spinal segments following laminectomy and whether these biomechanical parameters are affected by disc degeneration and bone mineral density (BMD).Methods
Ten human cadaveric lumbar spines were obtained (age 75.5, range 59–88). Disc degeneration (MRI) and BMD (DXA) were assessed. Disc degeneration was classified according to Pfirrmann and dichotomized in mild or severe. BMD was defined as high BMD (≥median BMD) or low BMD (<median BMD). Laminectomy was performed either on L2 (5×) or L4 (5×). Twenty motion segments (L2–L3 and L4–L5) were isolated. The effects of laminectomy, disc degeneration and BMD on torsion stiffness (TS) and torsion moments to failure (TMF) were studied.Results
Load–displacement curves showed a typical bi-phasic pattern with an early torsion stiffness (ETS), late torsion stiffness (LTS) and a TMF. Following laminectomy, ETS decreased 34.1 % (p < 0.001), LTS decreased 30.1 % (p = 0.027) and TMF decreased 17.6 % (p = 0.041). Disc degeneration (p < 0.001) and its interaction with laminectomy (p < 0.031) did significantly affect ETS. In the mildly degenerated group, ETS decreased 19.7 % from 7.6 Nm/degree (6.4–8.4) to 6.1 Nm/degree (1.5–10.3) following laminectomy. In the severely degenerated group, ETS decreased 22.3 % from 12.1 Nm/degree (4.6–21.9) to 9.4 Nm/degree (5.6–14.3) following laminectomy. In segments with low BMD, TMF was 40.7 % (p < 0.001) lower than segments with high BMD [34.9 Nm (range 23.7–51.2) versus 58.9 Nm (range 43.8–79.2)].Conclusions
Laminectomy affects both torsion stiffness and torsion load to failure. In addition, torsional strength is strongly affected by BMD whereas disc degeneration affects torsional stiffness. Assessment of disc degeneration and BMD pre-operatively improves the understanding of the biomechanical effects of a lumbar laminectomy. 相似文献2.
Arno Bisschop Barend J. van Royen Margriet G. Mullender Cornelis P. L. Paul Idsart Kingma Timothy U. Jiya Albert J. van der Veen Jaap H. van Die?n 《European spine journal》2012,21(12):2640-2648
Purpose
Reduced strength and shear stiffness (SS) of lumbar motion segments following laminectomy may lead to instability. The purpose of the present study was to assess a broad range of parameters as potential predictors of shear biomechanical properties of the lumbar spine.Methods
Radiographs and MRI of all lumbar spines were obtained to classify geometry and degeneration of the motion segments. Additionally, dual X-ray absorptiometry (DXA) scans were performed to measure bone mineral content and density (BMC and BMD). Facet sparing lumbar laminectomy was performed either on L2 or L4, in 10 human cadaveric lumbar spines (mean age 72.1 years, range 53–89 years). Spinal motion segments were dissected (L2–L3 and L4–L5) and tested in shear, under simultaneously loading with 1600 N axial compression. Shear stiffness, shear yield force (SYF) and shear force to failure (SFF) were determined and statistical correlations with all parameters were established.Results
Following laminectomy, SS, SYF, and SFF declined (by respectively 24, 41, and 44%). For segments with laminectomy, SS was significantly correlated with intervertebral disc degeneration and facet joint degeneration (Pfirrmann: r = 0.64; Griffith: r = 0.70; Lane: r = 0.73 and Pathria: r = 0.64), SYF was correlated with intervertebral disc geometry (r = 0.66 for length; r = 0.66 for surface and r = 0.68 for volume), BMC (r = 0.65) and frontal area (r = 0.75), and SFF was correlated with disc length (r = 0.73) and BMC (r = 0.81). For untreated segments, SS was significantly correlated with facet joint tropism (r = 0.71), SYF was correlated with pedicle geometry (r = 0.83), and SFF was correlated with BMC (r = 0.85), BMD (r = 0.75) and frontal area (r = 0.75). SS, SYF and SFF could be predicted for segments with laminectomy (r2 values respectively: 0.53, 0.81 and 0.77) and without laminectomy (r2 value respectively: 0.50, 0.83 and 0.83).Conclusions
Significant loss of strength and SS are predicted by BMC, BMD, intervertebral disc geometry and degenerative parameters, suggesting that low BMC or BMD, small intervertebral discs and absence of osteophytes could predict the possible development of post-operative instability following lumbar laminectomy. 相似文献3.
Y.-X. J. Wang J. F. Griffith H. T. Ma A. W. L. Kwok J. C. S. Leung D. K. W. Yeung A. T. Ahuja P. C. Leung 《Osteoporosis international》2011,22(1):91-96
Summary
The study cohort comprised 196 females and 163 males. Lumbar spine bone mineral density (BMD) and magnetic resonance imaging (MRI) were acquired. Females had more severe disc degeneration than males. Lumbar spine lower BMD was associated with less severe disc degeneration. Lumbar disc spaces were more likely to be narrower when vertebral BMD was higher. 相似文献4.
Feng G Wendlandt R Spuck S Schulz AP 《Clinical orthopaedics and related research》2012,470(7):2021-2028
Background
Anterior screw fixation has been widely adopted for the treatment of Type II dens fractures. However, there is still controversy regarding whether one- or two-screw fixation is more appropriate.Questions/Purposes
We addressed three questions: (1) Do one- and two-screw fixation techniques differ regarding shear stiffness and rotational stiffness? (2) Can shear stiffness and rotational stiffness after screw fixation be restored to normal? (3) Does stiffness after screw fixation correlate with bone mineral density (BMD)?Methods
We randomly assigned 14 fresh axes into two groups (seven axes each): one receiving one-screw fixation and another receiving two-screw fixation. Shear and torsional stiffness were measured using a nondestructive low-load test in six directions. A transverse osteotomy then was created at the base of the dens and fixed using one or two screws. Shear and torsional stiffness were tested again under the same testing conditions.Results
Mean stiffness in all directions after screw fixation was similar in both groups. The stiffness after one- and two-screw fixation was not restored to normal: the mean shear stiffness restored ratio was less than 50% and the mean torsional stiffness restored ratio was less than 6% in both groups. BMD did not correlate with mean stiffness after screw fixation in both groups.Conclusions
One- and two-screw fixation for Type II dens fractures provide similar stability but neither restores normal shear or torsional stiffness.Clinical Relevance
One-screw fixation might be used as an alternative to two-screw fixation. Assumed BMD should not influence surgical decision making. 相似文献5.
Jarred Kaiser Brett Allaire Paul M. Fein Darlene Lu Mohamed Jarraya Ali Guermazi Serkalem Demissie Elizabeth J. Samelson Mary L. Bouxsein Elise F. Morgan 《Archives of osteoporosis》2018,13(1):123
Summary
The distribution of bone tissue within the vertebra can modulate vertebral strength independently of average density and may change with age and disc degeneration. Our results show that the age-associated decrease in bone density is spatially non-uniform and associated with disc health, suggesting a mechanistic interplay between disc and vertebra.Purpose
While the decline of bone mineral density (BMD) in the aging spine is well established, the extent to which age influences BMD distribution within the vertebra is less clear. Measures of regional BMD (rBMD) may improve predictions of vertebral strength and suggest how vertebrae might adapt with intervertebral disc degeneration. Thus, we aimed to assess how rBMD values were associated with age, sex, and disc height loss (DHL).Methods
We measured rBMD in the L3 vertebra of 377 participants from the Framingham Heart Study (41–83 years, 181 M/196 F). Integral (Int.BMD) and trabecular BMD (Tb.BMD) were measured from QCT images. rBMD ratios (anterior/posterior, superior/mid-transverse, inferior/mid-transverse, and central/outer) were calculated from the centrum. A radiologist assigned a DHL severity score to adjacent intervertebral discs (L2–L3 and L3–L4).Results
Int.BMD and Tb.BMD were both associated with age, though the decrease across age was greater in women (Int.BMD, ??2.6 mg/cm3 per year; Tb.BMD, ??2.6 mg/cm3 per year) than men (Int.BMD, ??0.5 mg/cm3 per year; Tb.BMD, ??1.2 mg/cm3 per year). The central/outer (??0.027/decade) and superior/mid-transverse (??0.018/decade) rBMD ratios were negatively associated with age, with similar trends in men and women. Higher Int.BMD or Tb.BMD was associated with increased odds of DHL after adjusting for age and sex. Low central/outer ratio and high anterior/poster and superior/mid-transverse ratios were also associated with increased odds of DHL.Conclusions
Our results indicate that the distribution of bone within the L3 vertebra is different across age, but not between sexes, and is associated with disc degeneration.6.
Guido B. van Solinge Albert J. van der Veen Jaap H. van Dieën Idsart Kingma Barend J. van Royen 《European spine journal》2010,19(12):2130-2136
Degenerative lumbar spinal stenosis is the most common reason for lumbar surgery in patients in the age of 65 years and older.
The standard surgical management is decompression of the spinal canal by laminectomy and partial facetectomy. The effect of
this procedure on the shear strength of the spine has not yet been investigated in vitro. In the present study we determined
the ultimate shear force to failure, the displacement and the shear stiffness after performing a laminectomy and a partial
facetectomy. Eight lumbar spines of domestic pigs (7 months old) were sectioned to obtain eight L2–L3 and eight L4–L5 motion
segments. All segments were loaded with a compression force of 1,600 N. In half of the 16 motion segments a laminectomy and
a 50% partial facetectomy were applied. The median ultimate shear force to failure with laminectomy and partial facetectomy
was 1,645 N (range 1,066–1,985) which was significantly smaller (p = 0.012) than the ultimate shear force to failure of the control segments (median 2,113, range 1,338–2,659). The median shear
stiffness was 197.4 N/mm (range 119.2–216.7) with laminectomy and partial facetectomy which was significantly (p = 0.036) smaller than the stiffness of the control specimens (median 216.5, 188.1–250.2). It was concluded that laminectomy
and partial facetectomy resulted in 22% reduction in ultimate shear force to failure and 9% reduction in shear stiffness.
Although relatively small, these effects may explain why patients have an increased risk of sustaining shear force related
vertebral fractures after spinal decompression surgery. 相似文献
7.
Mark P Arts Ronald Brand Elske van den Akker Bart W Koes Wilco C Peul 《BMC musculoskeletal disorders》2010,11(1):122
Background
Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. 相似文献8.
BACKGROUND CONTEXT
Intervertebral disc degeneration has been subject to numerous in vivo and in vitro investigations and numerical studies during recent decades, reporting partially contradictory findings. However, most of the previous studies were limited in the number of specimens investigated and, therefore, could not consider the vast variety of the specimen geometries, which are likely to strongly influence the mechanical behavior of the spine.PURPOSE
To complement the understanding of the mechanical consequences of disc degeneration, whereas considering natural variations in the major spinal geometrical parameters.DESIGN/SETTING
A probabilistic finite element study.METHODS
A parametric finite element model of a human L4–L5 motion segment considering 40 geometrical parameters was developed. One thousand individual geometries comprising four degeneration grades were generated in a probabilistic manner, and the influence of the severity of disc degeneration on the mechanical response of the motion segment to different loading conditions was statistically evaluated.RESULTS
Variations in the individual structural parameters resulted in marked variations in all evaluated parameters within each degeneration grade. Nevertheless, the effect of degeneration in almost all evaluated response values was statistically significant. With degeneration, the intradiscal pressure progressively decreased. At the same time, the facet loads increased and the ligament tension was reduced. The initially nonlinear load-deformation relationships became linear whereas the segment stiffness increased.CONCLUSIONS
Results indicate significant stiffening of the motion segment with progressing degeneration and gradually increasing loading of the facets from nondegenerated to moderately degenerated conditions along with a significant reduction of the ligament tension in flexion. 相似文献9.
Background
The increase in the number of anterior lumbar interbody fusions being performed carries with it the potential for the long-term complication of adjacent segmental degeneration. While its exact mechanism remains uncertain, adjacent segment degeneration has become much more widespread. Using a nonlinear, three-dimensional finite element model to analyze and compare the biomechanical influence of anterior lumbar interbody fusion and lumbar disc degeneration on the superior adjacent intervertebral disc, we attempt to determine if anterior lumbar interbody fusion aggravates adjacent segment degeneration. 相似文献10.
Christian C Apfel Ozlem S Cakmakkaya William Martin Charlotte Richmond Alex Macario Elizabeth George Maximilian Schaefer Joseph V Pergolizzi 《BMC musculoskeletal disorders》2010,11(1):155
Background
Because previous studies have suggested that motorized non-surgical spinal decompression can reduce chronic low back pain (LBP) due to disc degeneration (discogenic low back pain) and disc herniation, it has accordingly been hypothesized that the reduction of pressure on affected discs will facilitate their regeneration. The goal of this study was to determine if changes in LBP, as measured on a verbal rating scale, before and after a 6-week treatment period with non-surgical spinal decompression, correlate with changes in lumbar disc height, as measured on computed tomography (CT) scans. 相似文献11.
José Antonio Balsa José I. Botella-Carretero Roberto Peromingo Carmen Caballero Teresa Muñoz-Malo Juan J. Villafruela Francisco Arrieta Isabel Zamarrón Clotilde Vázquez 《Obesity surgery》2010,20(4):468-473
Background
Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD). 相似文献12.
Jian Wang Yue Zhou Zheng Feng Zhang Chang Qing Li Wen Jie Zheng Jie Liu 《European spine journal》2013,22(3):489-494
Objective
To examine disc degeneration at levels adjacent and next adjacent to the fractured vertebra and to analyses, if the disc degeneration is determined by the endplate fracture.Summary of background data
Thoracolumbar burst fracture is one of the most common spinal injuries. The diagnostic (clinical and imaging) approach and treatment of a fractured vertebra is well established; however, some controversy remains. The associated disc degeneration is less well known after 9–12 months of the short segment pedicle screw fixations. There is a major controversy whether spinal trauma with vertebral endplate fractures can result in posttraumatic disc degeneration. No study to date, however, has assessed disc degeneration of the AO type A3 thoracolumbar fractures without neurologic deficits after pedicle screw fixations.Methods
Twenty-six patients with single-level AO type A3 thoracolumbar fractures and no neurological deficit were treated by using postural reduction and short segment percutaneous pedicle screw fixation. No laminectomy and fusion were performed. Implants were removed 9–12 months after the first operation. The thoracolumbar magnetic resonance imaging (MRI) was used to assess disc degeneration at levels adjacent and next adjacent to the fractured vertebra before the first operation and after the second operation in a retrospective study.Results
After the instrumentation removal, new disc degeneration was usually found at level adjacent to the cranial endplate of fractured vertebra by MRI examination in 24 patients. The average Pfirrmann grade of degenerative discs adjacent to the cranial fractured endplates deteriorated from 2.1 pre-operatively to 3.4 after the second operation. No change of disc degeneration was seen at the caudal disc space adjacent to the fractured vertebra and the levels next adjacent to the fractured vertebra. The discs next adjacent to the fractured vertebra were showed to be relatively normal without changes of degeneration during the study period.Conclusions
Disc degeneration usually occurs at level adjacent to the fractured endplate of thoracolumbar burst fractures. Endplate fracture is strongly associated with disc degeneration. No correlation between fixation level and disc degeneration is seen in this study. 相似文献13.
Background
The current standard of care for cervical myopathy is anterior discectomy and fusion (ACDF). Although well tolerated in the short term, this treatment might ultimately result in progressive degeneration of adjacent motion segments. Artificial disc arthroplasty offers the theoretical advantage of preservation of motion at the operative level with consequent stress reduction at adjacent levels. 相似文献14.
Fukuta S Miyamoto K Suzuki K Maehara H Inoue T Hara A Kikuike K Taguchi A Shimizu K 《Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society》2011,19(10):1254-1262
Objective
To assess the expression of calpains and calpain-induced aggrecan fragmentation in early and advanced stages of degeneration of human intervertebral discs (IVDs).Design
Disc tissue samples of 55 patients (mean age, 51.2 ± 22.3 years) who underwent intervertebral fusion were divided into groups with early and advanced degeneration based on the Thompson magnetic resonance imaging (MRI) scale. In advanced degeneration group, five patients (mean age, 35.5 ± 11.4 years) of lumbar disc herniation (LDH) were included. Protein levels of m- and μ-calpains and their inhibitor calpastatin were assayed, and immunohistochemical techniques were used to localize and quantify the production of the enzymes. To investigate calpain activity, we assayed purified aggrecan fragmentation in disc tissue by Western blotting and immunohistochemistry with VPGVA antibody, which recognizes the m-calpain generated neo-epitope GVA.Results
Discs at early stages of degeneration expressed low levels of m- and μ-calpains and calpastatin, and few cells expressed degenerative enzymes. At more advanced stages of degeneration, the expression and number of cells immunopositive for m-calpain, μ-calpain and calpastatin were significantly higher. Further finding showed that anti-GVA-reactive aggrecan fragments were significantly higher in discs at advanced compared with early stages of degeneration. Herniated disc samples showed stronger expression and more cells immunopositive for calpains, calpastatin and GVA in the nucleus pulposus than in the annulus fibrous.Conclusions
The expression of calpains, together with m-calpain-induced degradation products of extracellular matrix, was correlated with the degree of disc degeneration in human IVD tissue. These findings suggest that calpains may be involved in IVD degeneration via proteoglycan (PG) cleavage. 相似文献15.
Background
Many new treatments for degeneration of the intervertebral disc are being developed which can be delivered through a needle. These require testing in model systems before being used in human patients. Unfortunately, because of differences in anatomy, there are no ideal animal models of disc degeneration. Bovine explant model systems have many advantages but it is not possible to inject any significant volume into an intact disc. Therefore we have attempted to mimic disc degeneration in an explant bovine model via enzymatic digestion. 相似文献16.
The effects of bone density and disc degeneration on the structural property distributions in the lower lumbar vertebral endplates. 总被引:5,自引:0,他引:5
J P Grant Thomas R Oxland Marcel F Dvorak Charles G Fisher 《Journal of orthopaedic research》2002,20(5):1115-1120
In this study, we hypothesized that vertebral bone density and disc degeneration would affect the structural property distributions of the lower lumbar vertebral endplates (L3-L5). The results may have implications for improving interbody implant designs to better resist subsidence. A 3 mm diameter hemispherical indenter was used to perform indentation tests at 0.2 mm/s to a depth of 3 mm at 27 standardized locations in 55 bony endplates of intact human lumbar vertebrae (L3-L5). The resulting load-displacement curves were used to extract the failure load and stiffness of each test site. Bone density was measured using lateral DEXA scans. Disc condition was determined using a four-point grading scale. Three-way analyses of variance were used to analyze the relationships between the data. The overall failure load decreased with bone mineral density (BMD) in the superior (p < 0.0001) and inferior (p = 0.011) lumbar endplates. In both endplates, the posterolateral regions were significantly stronger than more central regions. With increasing BMD, this difference became more pronounced in the superior endplates only (p = 0.005). Increased disc degeneration was associated with an overall failure load decrease in the inferior lumbar endplates (p = 0.002). The strength in the central regions of the superior endplates was reduced with increasing degeneration, but this was not observed peripherally (p = 0.001). Stiffness magnitude or distribution was not significantly affected by BMD or disc degeneration. The locations of the strongest regions of the endplate did not change with either bone density or disc degeneration. This implies that implant shapes designed using the basic structural property maps for the L3-L5 endplates are appropriate for use in patients with a wide range of pathologies, even though overall failure loads are generally lower in patients with reduced bone density and greater degrees of disc degeneration. 相似文献
17.
W. D. Leslie L. M. Lix H. Johansson A. Oden E. McCloskey J. A. Kanis 《Osteoporosis international》2011,22(3):839-847
Summary
The FRAX? tool estimates a 10-year probability of fracture based upon multiple clinical risk factors and an optional bone mineral density (BMD) measurement obtained from the femoral neck. We describe a simple procedure for using lumbar spine BMD to enhance fracture risk assessment under the FRAX system. 相似文献18.
Rui Zhong Fuxin Wei Le Wang Shangbin Cui Ningning Chen Shaoyu Liu Xuenong Zou 《European spine journal》2016,25(9):2705-2715
Purpose
To evaluate the influence of osteoporosis on the microarchitecture and vascularization of the endplate in rhesus monkeys with or without intervertebral disc (IVD) degeneration using micro-computerized tomography (micro-CT), and to further analyze the correlation between osteoporosis and IVD degeneration.Methods
Twelve rhesus monkeys were randomly divided into the ovariectomy (OVX, n = 6) and the sham group (n = 6). The subchondral bone adjacent to the lumbar IVDs (from L4/5 to L6/7) of each monkey was randomly injected with 4 ml pingyangmycin (PYM) solution (1.5 mg/ml, PYM), or 4 ml phosphate buffered saline (PBS) as vehicle treatment, or exteriorized but not injected anything as control (Cntrl). Degenerative and osteoporotic processes were evaluated at different time points. Micro-CT and histology were performed to analyze microarchitecture, calcification area and vascularization of the endplate.Results
OVX resulted in significant decrease of bone mineral density (BMD). PYM injection induced progressively IVD degeneration, which was more progressive when combined with OVX. There was a negative correlation between BMD and Pfirrmann grade in the subgroups with PYM injection. The micro-CT analysis showed the combination of osteoporosis and IVD degeneration led to more calcification of endplate than any one thereof. The decrease of vascular volume percent in the endplate of the OVX-PYM subgroup was significantly greater than that in the Sham-PYM subgroup, both of which showed significant less vascularization compared to the other subgroups.Conclusion
In conclusion the osteoporosis could accumulate the calcification and decrease the vascularization in the endplates adjacent to the degenerated IVDs, which subsequently exacerbated degeneration of the degenerated IVDs.19.
Fabio Galbusera Hendrik Schmidt Cornelia Neidlinger-Wilke Andreas Gottschalk Hans-Joachim Wilke 《European spine journal》2011,20(4):563-571
Degeneration of the intervertebral disc is related to progressive changes in the disc tissue composition and morphology, such
as water loss, disc height loss, endplate calcification, osteophytosis. These changes may be present separately or, more frequently,
in various combinations. This work is aimed to the biomechanical investigation of a wide range of clinical scenarios of disc
degeneration, in which the most common degenerative changes are present in various combinations. A poroelastic non-linear
finite element model of the healthy L4–L5 human spine segment was employed and randomly scaled to represent ten spine segments
from different individuals. Six different degenerative characteristics (water loss in the nucleus pulposus and annulus fibrosus;
calcification and thickness reduction of endplate cartilage; disc height loss; osteophyte formation; diffuse sclerosis) were
modeled in 30 randomly generated models, 10 for each overall degree of degeneration (mild, moderate, severe). For each model,
a daily loading cycle including 8 h of rest, 16 h in the standing position with superimposed two flexion–extension motion
cycles was simulated. A tendency to an increase of stiffness with progressing overall degeneration was observed, in compression,
flexion and extension. Hence, instability for mild degeneration was not predicted. Facet forces and fluid loss decreased with
disc degeneration. Nucleus, annulus and endplate degeneration, disc height loss, osteophytosis and diffuse sclerosis all induced
a statistically significant decrease in the total daily disc height variation, facet force and flexibility in flexion–extension.
Therefore, grading systems for disc degeneration should include all the degenerative changes considered in this work, since
all of them had a significant influence on the spinal biomechanics. 相似文献
20.
Huiping Song Yang Luo Wenya Wang Shuyang Li Kai Yang Muwei Dai Yong Shen Yingze Zhang Liu Zhang 《The spine journal》2017,17(7):995-1003