Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis
Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the prese...
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Frontiers Media S.A.
2024-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1281119/full |
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| author | M. Kosterhon A. Müller A. Müller A. Müller R. Rockenfeller R. Rockenfeller A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar K. Gruber F. Ringel S. R. Kantelhardt |
| author_facet | M. Kosterhon A. Müller A. Müller A. Müller R. Rockenfeller R. Rockenfeller A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar K. Gruber F. Ringel S. R. Kantelhardt |
| author_sort | M. Kosterhon |
| collection | DOAJ |
| description | Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases.Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality.Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior–posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM.Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications. |
| first_indexed | 2024-03-08T15:59:27Z |
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| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-03-08T15:59:27Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-4e0ce5472a00458d97d5fc2d17a158632024-01-08T11:55:58ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852024-01-011110.3389/fbioe.2023.12811191281119Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesisM. Kosterhon0A. Müller1A. Müller2A. Müller3R. Rockenfeller4R. Rockenfeller5A. K. Aiyangar6A. K. Aiyangar7A. K. Aiyangar8A. K. Aiyangar9K. Gruber10F. Ringel11S. R. Kantelhardt12Department of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, GermanyInstitute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, GermanyMechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, SwitzerlandDepartment of Mathematics and Natural Science, Institute of Sports Science, University Koblenz, Koblenz, GermanyInstitute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, GermanyDepartment of Mathematics and Natural Science, Mathematical Institute, University Koblenz, Koblenz, GermanyMechanical Systems Engineering, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dübendorf, SwitzerlandDepartment of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, United StatesFaculty of Engineering and Sciences, University of Adolfo Ibanez, Vina del Mar, ChileFaculty of Medicine, University of Bern, Bern, SwitzerlandInstitute for Medical Engineering and Information Processing (MTI Mittelrhein), University Koblenz, Koblenz, GermanyDepartment of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, GermanyDepartment of Neurosurgery, Medical Center of the Johannes Gutenberg–University, Mainz, GermanyIntroduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases.Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality.Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior–posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM.Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications.https://www.frontiersin.org/articles/10.3389/fbioe.2023.1281119/fullbiomechanicsforward dynamic simulationspinal stenosisMBS modelinterlaminar fenestrationlaminectomy |
| spellingShingle | M. Kosterhon A. Müller A. Müller A. Müller R. Rockenfeller R. Rockenfeller A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar A. K. Aiyangar K. Gruber F. Ringel S. R. Kantelhardt Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis Frontiers in Bioengineering and Biotechnology biomechanics forward dynamic simulation spinal stenosis MBS model interlaminar fenestration laminectomy |
| title | Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| title_full | Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| title_fullStr | Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| title_full_unstemmed | Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| title_short | Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| title_sort | invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis |
| topic | biomechanics forward dynamic simulation spinal stenosis MBS model interlaminar fenestration laminectomy |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2023.1281119/full |
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