Abstract
This study was designed to measure the pressure distribution of the intervertebral disc under different degrees of distraction of the interspinous process, because of a suspicion that the degree of distraction of the spinous process may have a close relationship with the disc load share. Six human cadaver lumbar spine L2-L5 segments were loaded in flexion, neutral position, and extension. The L3-L4 disc load was measured at each position using pressure measuring films. Shape-memory interspinous process implants (SMID) with different spacer heights, ranging in size from 10 to 20 mm at 2 mm increments, were used. It was found that a SMID with a spacer height equal to the distance of the interspinous process in the neutral position can share the biomechanical disc load without a significant change of load in the anterior annulus. An interspinous process stabilizing device (IPD) would not be appropriate to use in those cases with serious spinal stenosis because the over-distraction of the interspinous process by the SMID would lead to overloading the anterior annulus which is a recognized cause of disc degeneration.
Highlights
The degeneration of the intervertebral disc and facet joint is the main cause of degenerative lumbar spinal stenosis (LSS) with clinical outcomes that include chronic low back pain (LBP) and neurogenic intermittent claudication (NIC)[1,2,3,4,5], The pathogenesis of degenerative LSS begins with degeneration of the
The shape-memory interspinous process device (SMID) with the 10 mm spacer height could not share the load on the disc in extension, neutral position, or flexion (P > 0.05)
The segment was slightly flexed with a SMID spacer height of 14 mm
Summary
The conventional treatment for the pain ranges from conservative (nonsteroidal anti-inflammatory drugs [NSAIDs], physical therapy, epidural steroid injection, and bracing) to surgical (decompressive laminectomy with or without fusion and instrumentation)[5,9]. The rate of successful fusion has increased, there has not been a comparable increase in successful clinical outcomes. Several studies have begun to study stabilization of the lumbar spine without fusion, which can stop LBP by improving the load-transfer of the lumbar spine using dynamic stabilization (DS) devices.[11] Compared to other kinds of DS devices, the non-fusion interspinous process stabilization device (IPD) is noteworthy in being minimally invasive surgery (MIS), showing faster recovery and rehabilitation, using local anesthesia during surgery, and having a low complication rate[2,4,5,12]
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