UBC Theses and Dissertations
Dynamic stabilization of the lumbar spine : an in vitro biomechanical investigation Niosi, Christina Anne
The Dynesys, a dynamic posterior stabilization system that provides an alternative to fusion, is designed to preserve intersegmental kinematics and reduce loading at the facet joints. Previous biomechanical investigations have analyzed kinematic behaviour using translations and/or rotations about a primary axis. The objective of this study was to conduct a comprehensive biomechanical evaluation to determine the effect of the Dynesys system on kinematic behaviour and load transfer and to examine the effect of variation in the length of the Dynesys spacer. Ten cadaveric lumbar spine segments (L2-L5) were subjected to pure moments of ±7.5 Nm in three loading directions with and without a compressive follower preload of 600 N. The flexibility tests were performed on the specimens under nine different conditions. Intervertebral positions were measured using an optoelectronic camera system, from which range of motion (ROM), neutral zone (NZ), and helical axis of motion (HAM) were calculated. Pressure sensors were placed inside the joint capsules to measure facet contact loads and custom needle pressure transducers were used to measure intradiscal pressures. Statistical significance was determined using repeated measures multivariate analysis of variance (MANOVA) (p < 0.05). The Dynesys resulted in a reduction in ROM to 16%, 30%, 25%, and 88% that of intact ROM in flexion, extension, lateral bending, and axial rotation. The device caused a posterior shift of the HAM in flexion-extension and axial rotation as well as a change in the orientation of the HAM. There was an increase in facet load in flexion with the Dynesys, an initial load created at the facet joints by installation of the system, and the anterior column load in the neutral position and axial rotation was reduced. In all three loading directions there was an increase in ROM with the long spacer and decrease with the short spacer compared to the standard spacer, with the largest difference seen in axial rotation. The long spacer resulted in a smaller posterior shift in the position of the HAM in axial rotation. Also evident was a reduction in the initial load at the facet joints and a decrease in facet load during flexion and lateral bending. The Dynesys created compression of the posterior elements and an asymmetric stiffness that both altered the kinematic behaviour and load transfer through the segment, and may have important clinical implications. The Dynesys reduced the large ROM that resulted after injury and allowed a ROM that was similar or greater than that of rigid fixation. However, with the emerging dynamic stabilization systems where motion is preserved, it becomes prudent to consider the complete motion pattern and load transfer through the segment when examining the efficacy of the device.
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