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EVALUATION OF PRESSURE AND MOBILITY OF ADJACENT SEGMENTS AFTER POSTERIOR LUMBAR FUSION. A BIOMECHANICAL STUDY.

Department of Trauma Surgery, Medical school, 30623 Hannover, Germany

The biomechanical effects on facet joints after posterior fusion remain unclear and seem to be responsible for accelerated degeneration. The following biomechanical study was performed to investigate the effects on the pressure and mobility of neighbouring unfused segments after double level T12-L2 posterior stabilization.

The experimental study was performed on eighteen fresh, human, cadaveric thoracolumbal spine specimens. The specimens were cleaned and dissected from muscles and fat with care to preserve bone-ligament units intact. In a specially constructed testing machine the data of the segmental pressure and mobility of adjacent segments above and below the fusion were measured before and after double level T12-L2 posterior stabilization with an internal fixator (Universal Spine System) in flexion, extension, lateral bending, and rotation. For measuring the mobility a motion tracker (3Space Fastrak) and for direct evaluation of the pressure a quartz miniature force transducer was used. Also the bone mineral density of the specimens were measured and showed normal values.

In flexion and extension Range of Motion (ROM) of the segment above the double level T12-L2 posterior fusion was significantly increased (p<0,05). In the adjacent segment below the fusion there was no significant increased mobility after fusion for each moment was applied. The pressure did not show any significant difference, but after posterior fusion in flexion and extension the pressure below the posterior fusion (L2/L3) was decreased and above the fusion (T11/T12) increased.

There is evidence that the adjacent segment above a double-level T12-L2 posterior fusion becomes more mobile and leads possibly to an accelerated degeneration in the facet joints due to increased stress at this point. Also the posterior fusion seems to change the load distribution in the facets of adjacent segments. These results could be responsible for symptoms like low back pain after spinal surgery.