Abstract
Fusion of spinal vertebrae can be accomplished by different surgical approaches. We investigated Traditional Open Spine Surgery (TOSS) versus Minimally Invasive Spine Surgery (MISS). While TOSS sacrifices spine muscles originating or inserting on the affected vertebrae, MISS seeks to minimize the approach-related morbidity and preserve the tendon attachments of the muscles in the area. We captured 3-D motions of the full body of one healthy subject performing a variety of 10 kg box lifting operations representing activities-of-daily-living that are likely to challenge the spine biomechanically. The motion data were transferred to a full-body biomechanical model with a detailed representation of the biomechanics of the spine, and simulations of the internal spine loads and muscle forces were performed under a baseline configuration and muscle configurations typical for TOSS respectively MISS for the cases of L3/L4, L4/L5, L5/S1, L4/S1 and L3/L5 fusions. The computational model was then used to investigate the biomechanical differences between surgeries. The simulations revealed that joint reaction forces are more affected by both surgical approaches for lateral lifting motions than for sagittal plane motions, and there are indications that individuals with fused joints, regardless of the approach, should be particularly careful with asymmetrical lifts. The MISS and TOSS approaches shift the average loads of different muscle groups in different ways. TOSS generally leads to higher post-operative muscle loads than MISS in the investigated cases, but the differences are smaller than could be expected, given the differences of surgical technique.
Highlights
Lumbar spinal fusion is a surgical procedure, where two or more of the spinal vertebrae are fused by means of mechanical devices and bone grafts
We present resulting joint reaction forces, which acted on the spinal disks, and changes of muscle group activities in response to fusion and approach combinations
In the sagittal plane lifts, A and B, the maximum lumbar loads over the motion were in the range 2800–3200 N and occurred when picking up the box in the beginning of the motion where spine flexion was at maximum
Summary
Lumbar spinal fusion is a surgical procedure, where two or more of the spinal vertebrae are fused by means of mechanical devices and bone grafts. Mobbs et al (2015) provided a comprehensive review of evidence, indications and surgical approaches. Presuming that the recovered patient will resume activities of daily living, the motion that previously took place between the fused vertebrae will be redistributed among adjacent spinal joints, which will sustain increased articulation to accommodate the same overall motion of the lumbar spine. The fusion is likely to redistribute the loads on muscles and joints in the region depending on surgical approaches, which might affect the health and longevity of the operated spine
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