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1.
Hao-Xuan Zhang Yuan-Dong Shao Yu Chen Yong Hou Lei Cheng Meng Si Lin Nie 《International orthopaedics》2014,38(12):2533-2541
Purpose
Total cervical artificial disc replacement (TDR) simulates normal disc structure, thus avoiding the drawbacks of anterior cervical decompression and fusion (ACDF). This prospective, randomized, controlled and multicentre study aimed to evaluate clinical and radiographic outcomes by comparing cervical disc replacement using Mobi-C disc prostheses with ACDF.Methods
This prospective, randomized, controlled and multicentre study consisted of 111 patients undergoing single-level Mobi-C disc prosthesis replacement (TDR group, n?=?55) or ACDF (n?=?56) from February 2008 to November 2009 at 11 medical centres across China. Patients were assessed before surgery, at seven days postoperation and one, three, six, 12, 24, 36 and 48 months postoperation. Clinical and neurological outcome was determined by measuring the Japanese Orthopaedic Association (JOA) scores, visual analogue scale (VAS) and Neck Disability Index (NDI). Static and dynamic radiographs were obtained of the cervical curvature, the functional spinal unit (FSU) angle and range of motion (ROM) of the cervical spine, FSU angle and treated and adjacent segments.Results
A total of 111 patients were included and randomly assigned to either Mobi-C disc prosthesis replacement or ACDF. JOA, VAS and NDI showed statistically significant improvements 48 months after surgery (P?0.05). ROM, FSU angle, treated segment and adjacent segments in the Mobi-C group were not significantly different before and after replacement (p?>?0.05). ROM in the ACDF group was significantly reduced at one month and remained so throughout the follow-up. By 48-months, more ACDF patients required secondary surgery (four of 56 patients).Conclusions
Although ACDF may increase the risk of additional surgery, clinical outcomes indicated that both Mobi-C artificial cervical disc replacement and ACDF were reliable. Radiographic data showed that ROM of the cervical spine, FSU angle and treated and adjacent segments were relatively better reconstructed and maintained in the Mobi-C group compared with those in the ACDF group. 相似文献2.
Daisuke Umebayashi Masahito Hara Yasuhiro Nakajima Yusuke Nishimura Toshihiko Wakabayashi 《European spine journal》2013,22(12):2884-2890
Purpose
The aim of this study was to compare the clinical features, radiological changes, biomechanical effects, and efficacy in patients treated by transvertebral anterior foraminotomy. Preservation of segmental motion and avoidance of adjacent segment degeneration are theoretical advantages of transvertebral anterior foraminotomy. In practice, this procedure is minimally invasive and has shown good clinical results, especially in patients with unilateral cervical radiculopathy.Method
We conducted a retrospective minimum 2-year follow-up study of the cervical spine of patients treated by transvertebral anterior foraminotomy at our institution. Radiological outcomes, which were estimated by measuring disc and functional spinal unit heights, and the angle and range of motion (ROM) from C2 to C7 of the functional spinal unit and adjacent segments were evaluated. Furthermore, a three-dimensional finite element method was used to biomechanically analyze the strength of the postoperative vertebral body.Results
Between 2004 and 2009, 34 patients underwent surgery. The improvement rate was 94.2 %. The average flexion–extension ROM from C2 to C7 was 36.6 ± 16.6°. On plain radiographs, the disc height and ROM and height of the functional spinal unit in the operated segment were not significantly decreased relative to the preoperative levels. The finite element method also revealed that there was no difference in strength between the pre- and postvertebral bodies.Conclusions
These results demonstrate that biomechanical stability was achieved. Transvertebral anterior cervical foraminotomy did not limit motion in the operated and adjacent segments and did not cause a significant decrease in disc and vertebral heights after surgery. 相似文献3.
R. J. Kroeze A. J. van der Veen B. J. van Royen R. A. Bank M. N. Helder T. H. Smit 《European spine journal》2013,22(12):2731-2739
Purpose
To relate the progress of vertebral segmental stability after interbody fusion surgery with radiological assessment of spinal fusion.Methods
Twenty goats received double-level interbody fusion and were followed for a period of 3, 6 and 12 months. After killing, interbody fusion was assessed radiographically by two independent observers. Subsequently, the lumbar spines were subjected to four-point bending and rotational deformation, assessed with an optoelectronic 3D movement registration system. In addition, four caprine lumbar spines were analysed in both the native situation and after the insertion of a cage device, as to mimic the direct post-surgical situation. The range of motion (ROM) in flexion/extension, lateral bending and axial rotation was analysed ex vivo using a multi-segment testing system.Results
Significant reduction in ROM in the operated segments was already achieved with moderate bone ingrowth in flexion/extension (71 % reduction in ROM) and with only limited bone ingrowth in lateral bending (71 % reduction in ROM) compared to the post-surgical situation. The presence of a sentinel sign always resulted in a stable vertebral segment in both flexion/extension and lateral bending. For axial rotation, the ROM was already limited in both native and cage inserted situations, resulting in non-significant differences for all radiographic scores.Discussion
In vivo vertebral segment stability, defined as a significant reduction in ROM, is achieved in an early stage of spinal fusion, well before a radiological bony fusion between the vertebrae can be observed. Therefore, plain radiography underestimates vertebral segment stability. 相似文献4.
Purpose
To determine the role of dynamic cervical implant (DCI) replacement for single-level degenerative cervical disc disease in Chinese patients.Methods
Thirty patients with single-level degenerative cervical disc disease were prospectively enrolled between April 2010 and August 2010 (12 women, 18 men; mean age 56.5 years). All patients underwent anterior cervical decompression, DCI replacement, clinical and radiological assessments preoperatively and at 1, 6, 12, and 24 months postoperatively, and Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Short Form 36 (SF-36) scores. Lateral neutral radiographs provided the intervertebral space height. Lateral dynamic radiographs were taken to measure the range of motion (ROM) of the cervical spine and functional spinal unit (FSU) of the treated segment. We compared the amount of motion of the adjacent vertebral endplate and the intrinsic motion of the implant and calculated a correlation analysis.Results
DCI showed good clinical and radiographic outcomes. At the final follow-up, JOA, VAS, NDI, and SF-36 average scores improved significantly. The intervertebral space height increased slightly after operation and was maintained during follow up. The ROM of the cervical spine and FSU decreased at early follow-up, but recovered to the preoperative level within 1–2 years. There was a high index of linear correlation between the motion of the adjacent vertebral endplate and the intrinsic motion of the implant.Conclusions
DCI provided elastic dynamic stability for the targeted segment, and restored and sustained intervertebral space height and ROM of the cervical spine. 相似文献5.
Background
Preservation of movement at the treated segment and possible reduction of adjacent segment effects is assumed to be an advantage of non-fusion technologies over fusion. The aim of this study was to compare the segmental range of motion (ROM) at the operative level, the cranial and caudal adjacent levels and the global lumbar spine ROM (L2-S1) after monosegmental fusion and total disc replacement (TDR).Patients and methods
Radiographic data was collected from 27 patients with level 1 degenerative disc disease operated at level L4/5. The ROM was assessed at the index level (L4/5), the cranial and caudal adjacent level and for the lumbar spine (L2-S1).Results
In the TDR group no significant changes of lumbar spine ROM (L2–S1) and segmental ROM (index level, cranial and caudal adjacent level) were noticed. In the fusion group there was a significant reduction of lumbar ROM (L2-S1) and index level ROM. Additionally the relative ROM in the adjacent caudal segment significantly increased while no changes were seen in the cranial segment.Conclusion
The relative ROM was significantly increased in monosegmental fusion at level L4/5 compared to TDR. To what extent this fact may result in early adjacent segment degeneration in cases of fusion compared to TDR is still unknown. 相似文献6.
Background
Few clinical studies have described the changes in the range of motion (ROM) of the cervical spine and adjacent segments following central corpectomy. We aimed to quantify the changes in range of motion (ROM) of the cervical spine and the adjacent segments at ≥24 months following uninstrumented central corpectomy (CC) for cervical spondylotic myelopathy (CSM) and to determine the contribution of the adjacent segments to the compensation for loss of motion of the cervical spine following CC. 相似文献7.
Daigo Morita Yasutsugu Yukawa Hiroaki Nakashima Keigo Ito Go Yoshida Masaaki Machino Syunsuke Kanbara Toshiki Iwase Fumihiko Kato 《European spine journal》2014,23(3):673-678
Study design
Imaging study of thoracic spine.Objective
The purpose of this study was to investigate dynamic alignment and range of motion (ROM) at all segmental levels of thoracic spine.Summary of background data
Thoracic spine is considered to have restricted ROM because of restriction by the rib cage. However, angular movements of thoracic spine can induce thoracic compressive myelopathy in some patients. Although few previous studies have reported segmental ROM with regard to sagittal plane, these were based on cadaver specimens. No study has reported normal functional ROM of thoracic spine.Methods
Fifty patients with cervical or lumbar spinal disease but neither thoracic spinal disease nor compression fracture were enrolled prospectively in this study (34 males, 16 females; mean age 55.4 ± 14.7 years; range 27–81 years). After preoperative myelography, multidetector-row computed tomography scanning was performed at passive maximum flexion and extension position. Total and segmental thoracic kyphotic angles were measured and ROM calculated.Results
Total kyphotic angle (T1/L1) was 40.2° ± 11.4° and 8.5° ± 12.8° in flexion and extension, respectively (P < 0.0001). The apex of the kyphotic angle was at T6/7 in flexion. Total ROM (T1/L1) was 31.7° ± 11.3°. Segmental ROM decreased from T1/2 to T4/5 but increased gradually from T4/5 to T12/L1. Maximum ROM was at T12/L1 (4.2° ± 2.1°) and minimum at T4/5 (0.9° ± 3.0°).Conclusions
Thoracic spine showed ROM in sagittal plane, despite being considered a stable region. These findings offer useful information in the diagnosis and selection of surgical intervention in thoracic spinal disease. 相似文献8.
Hartmann F Janssen C Böhm S Hely H Rommens PM Gercek E 《Archives of orthopaedic and trauma surgery》2012,132(9):1233-1239
Introduction
Decompression surgery represents the standard operative treatment for lumbar spinal stenosis, but this procedure is often combined with fusion surgery. It is still discussed whether minimal-invasive decompression procedures are sufficient and if they compromise spinal stability as well. The aim of this study was to analyze the effects of different minimal-invasive decompression procedures on the range of motion (ROM) of the decompressed and adjacent segments under preload conditions.Methods
Fourteen fresh frozen human cadaver lumbar spines (L2–L5) were tested in a spinal testing device with a moment of 7.5?N?m in flexion/extension, lateral bending and rotation with and without a preload. The ROM of the decompressed segment L3/4 and the adjacent segments L2/L3 and L4/L5 was measured intact and after creating a gradual defect with resection of the interspinous ligament (ISL), bilateral undercutting decompression, detachment of the supraspinous ligament (SSL) and bilateral medial facetectomy.Results
The resection of the ISL had no significant effect on the ROM of all segments. Undercutting decompression showed a significant increase in the ROM of all segments during flexion/extension and lateral bending. The detachment of the SSL caused a significant increase of ROM during flexion/extension in the instrumented and adjacent segments. After bilateral medial facetectomy, a decrease of ROM was observed in all directions of motion except flexion/extension with preload.Conclusions
The results support minimal-invasive procedures for the preservation of spinal stability. Therefore, surgeons can determine which grade of decompression procedure can be performed in the individual patient without requiring additional fusion to maintain spinal stability. 相似文献9.
Jie Tong Wei Ji Ruozhou Zhou Zhiping Huang Sheting Liu Qingan Zhu 《European spine journal》2016,25(6):1787-1793
Purpose
Transfacet screws have been used as an alternative posterior fixation in the cervical spine. There is lack of spinal stability of the transfacet screws either as stand-along constructs or combined with anterior plate. This study was designed to evaluate spinal stability of transfacet screws following posterior ligamentous injury and combined with anterior plate, respectively, and compare transfacet screws to lateral mass screw-rod constructs.Methods
Flexibility tests were conducted on eight cadaveric specimens in an intact and injury, and instrumented with the transfacet screw fixation and lateral mass screw-rod construct at C5–C7 levels either after section of the posterior ligamentous complex or combined with an anterior plate and a mesh cage for C6 corpectomy reconstruction. A pure moment of ±2.0 Nm was applied to the specimen in flexion–extension, lateral bending, and axial rotation. Ranges of motion (ROM) were calculated for the C5–C7 segment.Results
ROM with the transfacet screws was 22 % of intact in flexion–extension, 9 % in lateral bending and 11 % in axial rotation, while ROM with the lateral mass screw-rod construct was 9 % in flexion–extension, 8 % in lateral bending and 22 % in axial rotation. The only significant difference between two constructs was seen in flexion–extension (5.8 ± 4.2° vs. 2.4 ± 1.2°, P = 0.002). When combined with an anterior plate and mesh cage, the transfacet screw fixation reduced ROM to 3.0° in flexion–extension, 1.2° in lateral bending, and 1.1° in axial rotation, which was similar to the lateral mass screw-rod construct.Conclusions
This study identified the transfacet screw fixation, as stand-alone posterior fixation, was equivalent to the lateral mass screw-rod constructs in axial rotation and lateral bending except in flexion–extension. When combined with an anterior plate, the transfacet screw fixation was similar to the lateral mass screw-rod construct in motion constraint. The results suggested the transfacet screw fixation a biomechanically effective way as supplementation of anterior fixation.10.
Mazda K. Turel Sauradeep Sarkar Krishna Prabhu Roy T. Daniel K. S. Jacob Ari G. Chacko 《European spine journal》2013,22(7):1509-1516
Purpose
To determine whether motion preservation following oblique cervical corpectomy (OCC) for cervical spondylotic myelopathy (CSM) persists with serial follow-up.Methods
We included 28 patients with preoperative and at least two serial follow-up neutral and dynamic cervical spine radiographs who underwent OCC for CSM. Patients with an ossified posterior longitudinal ligament (OPLL) were excluded. Changes in sagittal curvature, segmental and whole spine range of motion (ROM) were measured. Nathan’s system graded anterior osteophyte formation. Neurological function was measured by Nurick’s grade and modified Japanese Orthopedic Association (JOA) scores.Results
The majority (23 patients) had a single or 2-level corpectomy. The average duration of follow-up was 45 months. The Nurick’s grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). 17 % of patients with preoperative lordotic spines had a loss of lordosis at last follow-up, but with no clinical worsening. 77 % of the whole spine ROM and 62 % of segmental ROM was preserved at last follow-up. The whole spine and segmental ROM decreased by 11.2° and 10.9°, respectively (p ≤ 0.001). Patients with a greater range of segmental movement preoperatively had a statistically greater range of movement at follow-up. The analysis of serial radiographs indicated that the range of movement of the whole spine and the range of movement at the segmental spine levels significantly reduced during the follow-up period. Nathan’s grade showed increase in osteophytosis in more than two-thirds of the patients (p ≤ 0.01). The whole spine range of movement at follow-up significantly correlated with Nathan’s grade.Conclusions
Although the OCC preserves segmental and whole spine ROM, serial measurements show a progressive decrease in ROM albeit without clinical worsening. The reduction in this ROM is probably related to degenerative ossification of spinal ligaments. 相似文献11.
Yingnuo Hou Yong Shen Zhongpo Liu Zhihong Nie 《Archives of orthopaedic and trauma surgery》2013,133(1):37-42
Purpose
To determine whether translaminar facet screws can provide stability equivalent to pedicle screws and whether the two posterior instrumentations have the same influence on the adjacent segments in two-level anterior lumbar interbody fusion.Methods
In a biomechanical study conducted, we used 12 fresh human lumbar spines and tested an intact spine with a stand-alone two-level anterior lumbar interbody fusion and anterior fusion augmented with pedicle screws or translaminar facet screws, under 400 N compressive preloads and 7.5 N m moments in flexion, extension, axial rotation and lateral bending, and measured the stiffness of the operated level, range of motion and intradiscal pressure at the adjacent levels.Results
We found a significant increase in the stiffness of the segments operated, range of motion and intradiscal pressure at the adjacent superior segment in the stand-alone two-level anterior lumbar interbody fusion during flexion, axial rotation and lateral bending, but a decrease in extension, when compared with the intact spine. The stiffness of operated segments, range of motion and intradiscal pressure in the adjacent segment are significantly higher in the two-level anterior lumbar interbody fusion augmented with posterior instrumentation than in the stand-alone two-level anterior lumbar interbody fusion. There was no significant difference between the two augmented constructs except that, at the adjacent superior segment, the intradiscal pressure was more in the construction augmented with a pedicle screw than with a translaminar facet screw in flexion.Conclusions
Translaminar facet screws can provide stability equivalent to pedicle screws, but their influence on the adjacent segments is relatively lower; therefore, we suggest that translaminar facet screws be the choice in the optimal posterior instrumentation in a two-level anterior lumbar interbody fusion. 相似文献12.
Jeong Yoon Park Kyung Hyun Kim Sung Uk Kuh Dong Kyu Chin Keun Su Kim Yong Eun Cho 《European spine journal》2013,22(5):1078-1089
Purpose
It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery.Materials and methods
This is a retrospective cross-sectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured.Results
The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2 % in the fusion group and 4.5 % in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50 %, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups.Conclusion
The ASD rate of 46.5 % after ACDF or arthroplasty, and arthroplasty did not significantly lower the rate of ASD. ASD occurred in patients who had preexisting ASD and in patients who also had other segment degeneration. ASD may be associated with a natural history of cervical spondylosis rather than arthrodesis. 相似文献13.
Bartosz Wojewnik Alexander J. Ghanayem Parmenion P. Tsitsopoulos Leonard I. Voronov Tejaswy Potluri Robert M. Havey Julia Zelenakova Alpesh A. Patel Gerard Carandang Avinash G. Patwardhan 《European spine journal》2013,22(1):135-141
Introduction
Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity.Methods
Thirteen human cadaveric subaxial cervical spines (C3–C7) were tested at C5–C6 in flexion–extension, lateral bending and axial rotation in the load-control mode under ±1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5–C6.Results
The anchored spacer device with locked screw configuration significantly reduced C5–C6 flexion–extension (FE) motion from 14.8 ± 4.2 to 3.9 ± 1.8°, lateral bending (LB) from 10.3 ± 2.0 to 1.6 ± 0.8, and axial rotation (AR) from 11.0 ± 2.4 to 2.5 ± 0.8 compared with intact under (p < 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5–C6 FE motion from 10.7 ± 1.7 to 5.5 ± 2.5°, LB from 8.3 ± 1.4 to 2.7 ± 1.0, and AR from 8.8 ± 2.7 to 4.6 ± 1.3 compared with intact (p < 0.01). The ROM of the C5–C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 ± 2.1 in FE, 2.0 ± 1.1 in LB, and 3.3 ± 1.4 in AR. Conversely, the ROM of the C5–C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 ± 4.5 in FE, 5.0 ± 1.6 in LB, and 9.5 ± 4.6 in AR.Conclusions
The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion–distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries. 相似文献14.
Jun Li Lei Liang Xiao-fei Ye Min Qi Hua-jiang Chen Wen Yuan 《European spine journal》2013,22(10):2303-2309
Purpose
The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed.Method
27 men and 28 women with a mean age of 46.4 ± 8.7 years were prospectively followed up for 2 years. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), visual analog scale (VAS) and Odom’s criteria. Radiographic information including segment and overall alignment, functional spinal unit (FSU) and overall ROM, and disc heights were prospectively collected during the follow-up. The correlations between the postoperative FSU ROM at last follow-up and influencing factors were analyzed.Results
Mean NDI, JOA and VAS scores showed statistical improvements at last follow-up. Anterior migration of the prosthesis was detected in six cases. Heterotopic ossification was observed in ten patients. Mean FSU angle, endplate angle of the treated level and mean overall cervical alignment were all improved significantly at last follow-up (P < 0.001). However, mean FSU ROM of the treated segment significantly decreased postoperatively (P = 0.008), while mean overall ROM showed no significant differences. A significant correlation was found between preoperative FSU ROM and postoperative FSU ROM by the Pearson correlation coefficient (r = 0.325, P = 0.034). Multiple linear regression analysis confirmed that preoperative FSU ROM contributed independently to a model with a coefficient of determination of 0.37 (P = 0.034).Conclusions
In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM. 相似文献15.
Introduction
Posterior lumbar interbody fusion (PLIF) and internal fixation are commonly performed for the treatment of lower back pain due to lumbar spinal degeneration. We have developed a novel interspinous fixation device, the interspinous fastener (ISF) for potential use in the surgical management of degenerative spinal disease. The aim of this study was to assess the in vitro biomechanical characteristics of calf lumbar spine specimens after ISF fixation with modified PLIF.Materials and methods
Ten lumbar spine (L3–L6) specimens from ten fresh calf cadavers (8–10 weeks of age) were used. Each specimen underwent sequential testing for each of the following four groups: no instrumentation (INTACT); interspinous fusion device fixation + PLIF (ISF); unilateral pedicle screw and titanium rod fixation + PLIF (UPS); bilateral pedicle screw and titanium rod fixation + PLIF (BPS). Outcome measures included angular range of motion (ROM) during unloaded and loaded (8 Nm) flexion, extension, left bending, right bending, left torsion and right torsion.Results
For all unloaded and loaded assessments, ROM was significantly higher in the INTACT group compared with all other groups (P < 0.05). Similarly, ROM was significantly higher in the UPS group (indicating decreased stability) compared with the ISF and BPS groups (P < 0.05). The only significant difference between the ISF and BPS groups was in the ROM with unloaded extension (higher in the BPS group, P = 0.006).Conclusions
We found that ISF fixation with PLIF of the lower lumbar spine provided biomechanical stability that was equivalent to that associated with bilateral pedicle screw/rod fixation with PLIF. The ISF shows potential as an alternative means of fixation in the surgical management of degenerative spinal disease. 相似文献16.
颈人工椎间盘置换术治疗颈椎病的临床研究 总被引:9,自引:0,他引:9
目的 探讨Bryan颈人工椎间盘假体置换术治疗颈椎病的临床疗效,同时与颈前路减压植骨融合术相比较,观察两种术式的近期临床疗效.方法 脊髓型和神经根型颈椎病患者共48例,21例(22个节段)行颈前路颈人工椎间盘假体置换术(置换组),27例(32个节段)采用颈前路减压植骨融合术(融合组).两组患者分别在术前,术后,术后3、6、12、18个月观察以下指标:JOA评分;摄颈椎前屈后伸位、左右侧屈位X线片,观察置换组的假体稳定性和植入节段及上下临近节段的活动度,观察融合组融合节段的上下临近节段的关节活动度;MRI或CT扫描检查颈人工椎间盘假体位置及有无异位骨化现象.结果 两组术后临床症状缓解,脊髓功能改善,均无并发症.两组JOA评分比较:术后各时间段较术前明显提高(P<0.01),两组术后各时间段之间的评分比较无显著差异.术后各时间段随访摄X线片显示:置换组置换节段较术前保留了部分关节活动度,上下临近关节活动度未显著增加,未发现假体偏移或下沉;而融合组临近节段活动度显著高于置换组(P<0.01).术后CT或MRI扫描显示:置换组假体位于临近上、下终板骨的中央,未见假体周围异位骨化现象;融合组出现1例下临近节段退变压迫脊髓.结论 与颈前路减压植骨融合术比较,颈人工椎间盘置换术既能良好地达到前路减压目的,又能保持颈椎病变节段的部分活动度和稳定性,且未显著增加上下临近节段活动度,取得了较好的近期临床疗效. 相似文献
17.
Bruno Bonnechère Patrick Salvia Pierre-Michel Dugailly Laura Maroye Bernard Van Geyt Véronique Feipel 《European spine journal》2014,23(8):1688-1693
Purpose
Cervical range of motion (RoM) has been the subject of many studies. However, only very few of these studies have considered the influence of movement execution speed on the cervical kinematics. The aim of this study is to evaluate the influence of movement speed on cervical RoM.Method
Cervical RoM was recorded using an optoelectronic system; 32 healthy subjects performed movements in two modes: the best possible and as fast as possible. Outcome measures: The primary movements (flexion–extension, lateral bending, axial rotation) and coupled movements were studied. Paired Student’s tests were performed to compare the two modes of movement.Results
The results showed that cervical RoM differed significantly between movement speeds. Amplitudes were higher for each movement (p < 0.001 for flexion–extension, p < 0.001 for lateral flexion, p = 0.008 for axial rotations) when movements were performed as quickly as possible. The range of movements carried out the best possible reached only 95 % of those during movements carried out as fast as possible. Concerning coupled movements, an increase in rotational movements coupled to lateral flexion during fast movements was observed.Conclusion
The range of motion reported in the literature corresponds to movement carried out in a mode resembling the best possible of our study. Movements made as quickly as possible can display larger motion ranges. 相似文献18.
Hiroyuki Tanahashi Kei Miyamoto Akira Hioki Nobuki Iinuma Takatoshi Ohno Katsuji Shimizu 《European spine journal》2013,22(12):2850-2856
Purpose
Alterations of three-dimensional cervical curvature in conventional anterior cervical approach position are not well understood. The purpose of this study was to evaluate alignment changes of the cervical spine in the position. In addition, simulated corpectomy was evaluated with regard to sufficiency of decompression and perforation of the vertebral artery canal.Methods
Fifty patients with cervical spinal disorders participated. Cervical CT scanning was performed in the neutral and supine position (N-position) and in extension and right rotation simulating the conventional anterior approach position (ER-position). Rotation at each vertebral level was measured. With simulation of anterior corpectomy in a vertical direction with a width of 17 mm, decompression width at the posterior wall of the vertebrae and the distance from each foramen of the vertebral artery (VA) were measured.Results
In the ER-position, the cervical spine was rotated rightward by 37.2° ± 6.2° between the occipital bone and C7. While the cervical spine was mainly rotated at C1/2, the subaxial vertebrae were also rotated by several degrees. Due to the subaxial rotation, the simulated corpectomy resulted in smaller decompression width on the left side and came closer to the VA canal on the right side.Conclusions
In the ER-position, the degrees of right rotation of subaxial vertebrae were small but significant. Therefore, preoperative understanding of this alteration of cervical alignment is essential for performing safe and sufficient anterior corpectomy of the cervical spine. 相似文献19.
Wolfram Käfer Balkan Cakir Stefan Midderhoff Heiko Reichel Hans-Joachim Wilke 《European spine journal》2014,23(11):2330-2339
Purpose
To assess segmental angulation and mobility following implantation of the Charité artificial disc in combination with the posterior dynamic fixation device dynamic stabilization system (DSS) and the interspinous spacer Coflex at the L4–L5 segment, respectively.Methods
Six human L4–L5 specimens were loaded with pure moments of ±7.5 Nm in flexion/extension, lateral bending, and axial rotation in a custom-made spine tester. The testing protocol was as follows: (a) intact condition, (b) destabilization by resection of the anterior longitudinal ligament (ALL), (c) implantation of the Charité with retained posterior longitudinal ligament (PLL), (d) supplemental DSS implantation, (e) removal of DSS rods and PLL resection, (f) DSS rod re-implantation, (g) enlargement of rod length, and (h) removal of DSS and implantation of Coflex. Range of motion (ROM), neutral zone, and segmental angulation were determined.Results
ALL resection did not influence significantly ROM. TDR increased lateral bending and axial rotation only after resection of the PLL, whereas flexion/extension remained unchanged. DSS limited all degrees of freedom prior to and after PLL resection. Rod length enlargement had no significant effect. Coflex limited significantly flexion/extension compared to the intact state and TDR, whereas lateral bending and axial rotation remained unchanged. TDR increased lordosis, whereas Coflex had a substantial kyphosing effect.Conclusions
This study demonstrates that posterior dynamic stabilization in combination with TDR reduces flexion/extension ROM and segmental lordosis in a monosegmental biomechanical model. 相似文献20.
Albrecht Waschke Szymon Kaczor Jan Walter Pedro Duenisch Rolf Kalff Christian Ewald 《Acta neurochirurgica》2013,155(5):801-807