Abstract

Purpose

To develop ligamentous vertebral stabilization techniques (“vertebropexy”) that can be used after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures) and to elaborate their biomechanical characteristics.

Methods

Fifteen spinal segments were biomechanically tested in a stepwise surgical decompression and ligamentous stabilization study. Stabilization was achieved with a gracilis or semitendinosus tendon allograft, which was attached to the spinous process (interspinous vertebropexy) or the laminae (interlaminar vertebropexy) in form of a loop. The specimens were tested (1) in the native state, after (2) microsurgical decompression, (3) interspinous vertebropexy, (4) midline decompression, and (5) interlaminar vertebropexy. In the intact state and after every surgical step, the segments were loaded in flexion–extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR).

Results

Interspinous vertebropexy significantly reduced the range of motion (ROM) in all loading scenarios compared to microsurgical decompression: in FE by 70% (p < 0.001), in LS by 22% (p < 0.001), in LB by 8% (p < 0.001) in AS by 12% (p < 0.01) and in AR by 9% (p < 0.001). Interlaminar vertebropexy decreased ROM compared to midline decompression by 70% (p < 0.001) in FE, 18% (p < 0.001) in LS, 11% (p < 0.01) in LB, 7% (p < 0.01) in AS, and 4% (p < 0.01) in AR. Vertebral segment ROM was significantly smaller with the interspinous vertebropexy compared to the interlaminar vertebropexy for all loading scenarios except FE. Both techniques were able to reduce vertebral body segment ROM in FE, LS and LB beyond the native state.

Conclusion

Vertebropexy is a new concept of semi-rigid spinal stabilization based on ligamentous reinforcement of the spinal segment. It is able to reduce motion, especially in flexion–extension. Studies are needed to evaluate its clinical application.

Details

Title
Vertebropexy as a semi-rigid ligamentous alternative to lumbar spinal fusion
Author
Farshad, Mazda 1 ; Tsagkaris, Christos 2 ; Widmer, Jonas 2 ; Fasser, Marie-Rosa 2 ; Cornaz, Frédéric 3 ; Calek, Anna-Katharina 3   VIAFID ORCID Logo 

1  Balgrist University Hospital, University of Zurich, Department of Orthopedics, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650); University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650) 
2  ETH Zurich, Institute of Biomechanics, Zurich, Switzerland (GRID:grid.5801.c) (ISNI:0000 0001 2156 2780); Balgrist University Hospital, University of Zurich, Spine Biomechanics, Department of Orthopedic Surgery, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650) 
3  Balgrist University Hospital, University of Zurich, Department of Orthopedics, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650) 
Pages
1695-1703
Publication year
2023
Publication date
May 2023
Publisher
Springer Nature B.V.
ISSN
09406719
e-ISSN
14320932
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s00586-023-07647-y
ProQuest document ID
2817211149
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.