In vitro biomechanical evaluation of a strutted intradiscal spacer for lumbar discectomy

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-03-12 DOI:10.1016/j.clinbiomech.2025.106491

Werner Schmoelz , Anna Spicher , Richard Lindtner , Romed Hörmann , Robin Srour

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引用次数: 0

Abstract

Background

Discectomy plus implantation of a strutted intradiscal spacer has been shown to reduce reoperations and reherniations versus discectomy alone following lumbar disc herniation. This study explored the underlying biomechanics of the intradiscal spacer.

Methods

Six fresh-frozen cadaveric lumbar spine specimens (L2 to L5) from three donors were used. Following box annulotomy to simulate disc herniation, a discectomy was performed. One segment from each donor was randomly assigned to either an untreated control group or the test group where an intradiscal spacer was implanted. A six degree of freedom universal spine tester assessed range of motion (RoM) in flexion/extension, lateral bending and axial rotation in the native state in load controlled [±7.5 Nm] and intervals up to 60,000 cycles. Disc height was measured on fluoroscopy for multiple timepoints. The segments were also analyzed to detect possible reherniation during the cycling loading.

Findings

Following 60,000 cycles, the mean percentage RoM increase versus the intact state was less for discectomy plus the intradiscal spacer versus discectomy alone for lateral bending (170.7 ± 10.0 vs. 222.5 ± 33.3 %), flexion/extension (178.5 ± 6.1 vs. 204.6 ± 44.3 %) and axial rotation (284.4 ± 127.2 vs. 362.3 % ± 240.4 %). Mean overall disc height loss versus the annulotomy state was also less with the intradiscal spacer versus discectomy alone (−19.3 ± 3.7 vs. -29.1 ± 6.1 %). There was no evidence of device subsidence or migration.

Interpretation

This study helps to explain the clinical observation that insertion of a strutted intradiscal spacer following discectomy reduces reherniation rate by mechanically limiting the increase in RoM and disc height loss following lumbar discectomy.

查看原文本刊更多论文

腰椎间盘切除术中支撑型椎间盘内间隔器的体外生物力学评价

背景：与单纯椎间盘切除术相比，椎间盘切除术加椎间盘内支架植入可减少腰椎间盘突出后的再手术和再突出。本研究探讨了椎间盘内间隔器的潜在生物力学。方法采用3例新鲜冷冻尸体腰椎标本（L2 ~ L5）。在盒状环切开术模拟椎间盘突出后，行椎间盘切除术。每个供体的一段被随机分配到未经治疗的对照组或植入椎间盘内间隔器的试验组。六自由度通用脊柱测试仪在负载控制[±7.5 Nm]和间隔高达60,000次循环的情况下，评估在自然状态下屈伸、侧向弯曲和轴向旋转的运动范围（RoM）。在多个时间点的透视下测量椎间盘高度。在循环加载过程中，还分析了这些节段以检测可能的再疝。结果：在6万次手术周期后，椎间盘切除术加椎间盘内间隔器治疗侧弯（170.7±10.0 vs. 222.5±33.3%）、屈伸（178.5±6.1 vs. 204.6±44.3%）和轴向旋转（284.4±127.2 vs. 362.3%±240.4%）相对于完整状态的平均RoM增加百分比低于单纯椎间盘切除术。椎间盘内间隔器与单纯椎间盘切除术相比，椎间盘环切开术的平均总椎间盘高度损失也更少（- 19.3±3.7 vs -29.1±6.1%）。没有证据表明设备下沉或移动。本研究有助于解释临床观察，即椎间盘切除术后置入有支撑的椎间盘内间隔器通过机械地限制椎间盘切除术后RoM的增加和椎间盘高度损失来降低再突出率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.