Yogesh Kumaran1, Anoli Shah1, Akhil Katragadda1, Adit Padgaonkar1, Joseph Zavatsky2, Robert McGuire3, Hassan Serhan4, Hossein Elgafy1, Vijay K Goel5. 1. The Engineering Center for Orthopaedic Research Excellence (E-CORE), Toledo, OH, US. 2. Spine and Scoliosis Specialists, Tampa, FL, US. 3. University of Mississippi Medical Center, Jackson, MS, US. 4. Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, US. 5. The Engineering Center for Orthopaedic Research Excellence (E-CORE), Toledo, OH, US. Vijay.Goel@utoledo.edu.
Abstract
PURPOSE: Lumbar procedures for Transforaminal Lumbar Interbody Fusion (TLIF) range from open (OS) to minimally invasive surgeries (MIS) to preserve paraspinal musculature. We quantify the biomechanics of cross-sectional area (CSA) reduction of paraspinal muscles following TLIF on the adjacent segments. METHODS: ROM was acquired from a thoracolumbar ribcage finite element (FE) model across each FSU for flexion-extension. A L4-L5 TLIF model was created. The ROM in the TLIF model was used to predict muscle forces via OpenSim. Muscle fiber CSA at L4 and L5 were reduced from 4.8%, 20.7%, and 90% to simulate muscle damage. The predicted muscle forces and ROM were applied to the TLIF model for flexion-extension. Stresses were recorded for each model. RESULTS: Increased ROM was present at the cephalad (L3-L4) and L2-L3 level in the TLIF model compared to the intact model. Graded changes in paraspinal muscles were seen, the largest being in the quadratus lumborum and multifidus. Likewise, intradiscal pressures and annulus stresses at the cephalad level increased with increasing CSA reduction. CONCLUSIONS: CSA reduction during the TLIF procedure can lead to adjacent segment alterations in the spinal element stresses and potential for continued back pain, postoperatively. Therefore, minimally invasive techniques may benefit the patient.
PURPOSE: Lumbar procedures for Transforaminal Lumbar Interbody Fusion (TLIF) range from open (OS) to minimally invasive surgeries (MIS) to preserve paraspinal musculature. We quantify the biomechanics of cross-sectional area (CSA) reduction of paraspinal muscles following TLIF on the adjacent segments. METHODS: ROM was acquired from a thoracolumbar ribcage finite element (FE) model across each FSU for flexion-extension. A L4-L5 TLIF model was created. The ROM in the TLIF model was used to predict muscle forces via OpenSim. Muscle fiber CSA at L4 and L5 were reduced from 4.8%, 20.7%, and 90% to simulate muscle damage. The predicted muscle forces and ROM were applied to the TLIF model for flexion-extension. Stresses were recorded for each model. RESULTS: Increased ROM was present at the cephalad (L3-L4) and L2-L3 level in the TLIF model compared to the intact model. Graded changes in paraspinal muscles were seen, the largest being in the quadratus lumborum and multifidus. Likewise, intradiscal pressures and annulus stresses at the cephalad level increased with increasing CSA reduction. CONCLUSIONS:CSA reduction during the TLIF procedure can lead to adjacent segment alterations in the spinal element stresses and potential for continued back pain, postoperatively. Therefore, minimally invasive techniques may benefit the patient.
Authors: Salvador A Brau; Rick B Delamarter; Michael L Schiffman; Lytton A Williams; Robert G Watkins Journal: Spine J Date: 2004 Jul-Aug Impact factor: 4.166
Authors: Yevgeniya S Kushchayeva; Sergiy V Kushchayev; Tetiana Y Glushko; Sri Harsha Tella; Oleg M Teytelboym; Michael T Collins; Alison M Boyce Journal: Insights Imaging Date: 2018-11-27