Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine

Abstract Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling stu...

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Autores principales:	Mahdi Ebrahimkhani, Navid Arjmand, Aboulfazl Shirazi-Adl
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/27021777c3b9490c93c02c0e9363618f
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spelling	oai:doaj.org-article:27021777c3b9490c93c02c0e9363618f2021-12-02T14:58:46ZBiomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine10.1038/s41598-021-97288-22045-2322https://doaj.org/article/27021777c3b9490c93c02c0e9363618f2021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-97288-2https://doaj.org/toc/2045-2322Abstract Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling studies have numerous shortcomings when simulating the complex structures of the spine and the pre/postoperative mechanobiology of the patient. The biomechanical effects of the L4–L5 fusion surgery on muscle forces and adjacent segment kinetics (compression, shear, and moment) were investigated using a validated musculoskeletal model. The model was driven by in vivo kinematics for both preoperative (intact or severely degenerated L4–L5) and postoperative conditions while accounting for muscle atrophies. Results indicated marked changes in the kinetics of adjacent L3–L4 and L5–S1 segments (e.g., by up to 115% and 73% in shear loads and passive moments, respectively) that depended on the preoperative L4–L5 disc condition, postoperative lumbopelvic kinematics and, to a lesser extent, postoperative changes in the L4–L5 segmental lordosis and muscle injuries. Upper adjacent segment was more affected post-fusion than the lower one. While these findings identify risk factors for adjacent segment disorders, they indicate that surgical and postoperative rehabilitation interventions should focus on the preservation/restoration of patient’s normal segmental kinematics.Mahdi EbrahimkhaniNavid ArjmandAboulfazl Shirazi-AdlNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mahdi Ebrahimkhani Navid Arjmand Aboulfazl Shirazi-Adl Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
description	Abstract Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling studies have numerous shortcomings when simulating the complex structures of the spine and the pre/postoperative mechanobiology of the patient. The biomechanical effects of the L4–L5 fusion surgery on muscle forces and adjacent segment kinetics (compression, shear, and moment) were investigated using a validated musculoskeletal model. The model was driven by in vivo kinematics for both preoperative (intact or severely degenerated L4–L5) and postoperative conditions while accounting for muscle atrophies. Results indicated marked changes in the kinetics of adjacent L3–L4 and L5–S1 segments (e.g., by up to 115% and 73% in shear loads and passive moments, respectively) that depended on the preoperative L4–L5 disc condition, postoperative lumbopelvic kinematics and, to a lesser extent, postoperative changes in the L4–L5 segmental lordosis and muscle injuries. Upper adjacent segment was more affected post-fusion than the lower one. While these findings identify risk factors for adjacent segment disorders, they indicate that surgical and postoperative rehabilitation interventions should focus on the preservation/restoration of patient’s normal segmental kinematics.
format	article
author	Mahdi Ebrahimkhani Navid Arjmand Aboulfazl Shirazi-Adl
author_facet	Mahdi Ebrahimkhani Navid Arjmand Aboulfazl Shirazi-Adl
author_sort	Mahdi Ebrahimkhani
title	Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
title_short	Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
title_full	Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
title_fullStr	Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
title_full_unstemmed	Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
title_sort	biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/27021777c3b9490c93c02c0e9363618f
work_keys_str_mv	AT mahdiebrahimkhani biomechanicaleffectsoflumbarfusionsurgeryonadjacentsegmentsusingmusculoskeletalmodelsoftheintactdegeneratedandfusedspine AT navidarjmand biomechanicaleffectsoflumbarfusionsurgeryonadjacentsegmentsusingmusculoskeletalmodelsoftheintactdegeneratedandfusedspine AT aboulfazlshiraziadl biomechanicaleffectsoflumbarfusionsurgeryonadjacentsegmentsusingmusculoskeletalmodelsoftheintactdegeneratedandfusedspine
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Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine

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