Derece 1 spondiloisthezis modeli oluşturulmuş insan kadavrasında Kafes (cage) ve kemik greftin anterior interkorporal uygulamasının biyomekanik olarak karşılaştırılması
Başlık çevirisi mevcut değil.
- Tez No: 71293
- Danışmanlar: PROF. DR. MEHMET ZİLELİ
- Tez Türü: Tıpta Uzmanlık
- Konular: Nöroşirürji, Neurosurgery
- Anahtar Kelimeler: Kemik nakli, Omurga, Spondilolistezis, Bone transplantation, Spine, Spondylolisthesis
- Yıl: 1998
- Dil: Türkçe
- Üniversite: Ege Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Nöroşirürji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: Belirtilmemiş.
Özet
SUMMARY In the management of degenerative conditions of the lumbar spine, spinal fusion is a popular management option. Intervertebral body arthrodesis or fusion of a lumbar spine segment is indicated for symptomatic patients with intervertebral disc disease and instability. The purpose of the fusion in these cases is to eliminate or reduce the amount of motion at that site, and possibly, the source of pain. Anterior lumbar interbody fixation (ALIF) has been proven clinically effective in restoring spinal stability in cases of grade 1 degenerative spondylolisthesis. However, biomechanical evaluation of ALIF for treatment of spondylolisthesis has not been performed previously. Furthermore, the amount of additional stability contributed to ALIF by pedicle screw/rod fixation has not been quantified. We performed a biomechanical study first to attempt to model spondylolisthesis in vitro, then to quantify the performance of ALIF and pedicle screws in this model. Seven human cadaveric lumbar spines were studied by applying non-constraining nondestructive pure moments (maximum 5.0 Nm) and anteroposterior shear forces (maximum 70 N) while measuring individual-level 3-D movement from LI -2 to L5-sacrum. Specimens were tested normal, after destabilization to mimic grade 1 degenerative spondylolisthesis, and after surgical fixation. For destabilization, facets were partial resected and disc material was removed through small incisions without excessively damaging ligaments. Surgical fixation consisted of anterior insertion of titanium cages or cortical threaded bone dowels and subsequently, TSRH pedicle screw/rods. With destabilization, angular range of motion (ROM) increased by combined. Anteroposterior translation increased by an average of 2.8±1.4mm (431±334%). Metallic cages stabilized the spine approximately equivalents to cortical bone. When stabilized using either cages or dowels, angular ROM was reduced and anteroposterior translational motion by an average of 2.3±1.5 mm (65±36%). However, motion was not reduced to within the normal range. Pedicle screw fixation combined with cages or dowels reduced specimen angular motions less than cages or dowels alone and translation less than cages/dowels alone. Cages or dowels added to pedicle screw fixation produced a construct that was statistically significantly more stable than pedicle screw alone (p<0.05). It is possible to model degenerative spondylolisthesis in vitro, but difficult to create instability of more than grade 1. Cages and dowels behave similarly in their ability to stabilize 53en güçlü stabîltzasyonu sağlamaktadır. Ayrıca testkemikgevşediği ve yerinden çıktığı gözlemlenmiştir (2 seviyede kemik greft çıktı). Kafes, derece l dejeneratif spondilolisthezis tedavisinde alternatif bir tedavi yöntemidir. Kafes pösterior ve posterolateral fuzyonlara göre klinik ve biyomekanik avantajları vardır. Disk aralığınıgenişlemesini, sağlar. Kafes üzerinde yer alan delkler kemik ftiıyon oluşmasını kolaylaştırır. Kafes, împlant çıkması, gevşemesi ve kırılması gibi problemleri önler. Ayrıca uygulaması koiay, ameliyat süresini ve kanama miktarını azaltmaktadır.
Özet (Çeviri)
SUMMARY in the management of ctegenerafîve conditîons of the lombar spine, spiral fiısîon is a popularoption. Iııtervertebral bodyör âısion of a lunıbar segrnent îs indicaled fer symptomatîc palîents witl interveıtebral dişe disease instabîlity. The purpose of the fiısîon inis toör reduce theof motion at (hat site, possibly, the source of paîıı Anterior lombar interbody ftjcatietn (ALIF) hasclinîcally effective in restoring spinal stability in cases of grade l degenerative spondylolisthesîs, However, biomechanical evaluatîon of ALIF for treatment of spondylolîsthesis his not performed previously. Furthermore, the arnount of addîtionai stabîüfy contrîbuted to ALIF by pedicle screw/rod fixation has not been quantifted. We peıformed a Momeciıanicat study first to afteınpt to model spondylolistfıesis İH vifro, then to quantify the performance of ALIF and pedîcle screws in this model. Seven huınan cadaveric lumbar spînesby appiying non-constrsinîng nondestructive püre(masintum 5.0 Ntn) anteroposterior shear forces {maxîjnum 70 N) whîte ıneasuring individual-level 3-Dfronı LI-2 to LS-sacrunı. Specinıens were tested normal, after destabiltzation to minıîcJ degenerative spondylolislhesis, afterfixation. For destabîlization,and removed through small încisions without excessively damagiıg lîgaments. Surgîcal fixation consisted of anterior însertion of îjtaniutnör cortical tlretded bone dowels subsequently, TSRH pedicle screw/rods. With destabiiizatîon, angularof tnotîon (ROM) increased by combîned. Ânîeroposterior translalion increased by anof 2J±1.4nını (43I±334%), Metalle iheapproximately equivalently tobone. When slabiiized usîng either ör dowels, angıılar ROM was reduced anteroposterior translatîonal rootion by an average of 2.3±1.5 (65±36%). However, roofîon was not reduced to withîn the normal range. Pedîcle screw fixatîon corobined wîthör doweis reduced specinıen angular roofîons lessör dowelsand translation less !han cages/dowel$ aione. Cages ör dowelsto pedicle screw fmations constmct that was statisticatly signifîcantly more stable Ihan pedîcle screw aione (p<0.05). it is possible to model degenerative spondylolisthesîs iıı vitra, but difficult to create insfability of nıore îlan grade 1. Cages and dowels behave simîlarly in theîr abilify to stabilize «grade l spondyloiisîhesîs, probably because they are nearly îdentîcal in geometry, in vitro, pediele screw instrumentatton tdds a large amount of stabiltty to ALIF, but ALIF only a snıalî anıount of stability to pedîcle screw fixation. in vilro this biomechanical study in destabîlized human luntbar spine segtnents detıonslrate that the lumbâr threaded interbody compıred to thethethe stiffness of segments, Threaded interbody ftısîon cages are viable altematives for treating degenerstive dîsc disease and grade I degeneratîve spondylolisthesis of the lumbâr spîne- Those cages are designed with large fenestrations on the cephalad and caudat surfaces and they have snıalier lateral fenestrations to aîlow bone ingrowth and consolîdaîion through and around the cages. The cages are «Jesîgned to prevent împlant estrusîon, tmptant breakage, dişe space collapse, and nonunion. The tlıreads of the cage are anchored into the vertebral end plates above and below the dişe space to resist shear loads and prevent migration of the cage. Theare stabilized further by being placed under compressive loads, The cages are very strotıg and untikely to break.
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