Prospective surgical solutions in degenerative spine: spinal simulation for optimal choice of implant and targeted device development.

Autor:	Salchow-Gille M; Short Care Clinic, Greifswald, Germany., Rieger B; Short Care Clinic, Greifswald, Germany.; Klinikum Herford, Spine Surgery, Herford, Germany.; Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany.; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany., Reinshagen C; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Molcanyi M; Institute of Neurophysiology, Medical Faculty, University of Cologne, Cologne, Germany.; Department of Neurosurgery, Research Unit for Experimental Neurotraumatology, Medical University Graz, Graz, Austria., Lemke J; Klinikum Herford, Spine Surgery, Herford, Germany., Brautferger U; Department of Urology, University Hospital of Rostock, Rostock, Germany., Sitoci-Ficici KH; Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany., Polanski W; Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany., Pinzer T; Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany., Schackert G; Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany.; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany.
Jazyk:	angličtina
Zdroj:	Innovative surgical sciences [Innov Surg Sci] 2021 Apr 07; Vol. 6 (1), pp. 11-24. Date of Electronic Publication: 2021 Apr 07 (Print Publication: 2021).
DOI:	10.1515/iss-2019-1002
Abstrakt:	Objectives: The most important goal of surgical treatment for spinal degeneration, in addition to eliminating the underlying pathology, is to preserve the biomechanically relevant structures. If degeneration destroys biomechanics, the single segment must either be surgically stabilized or functionally replaced by prosthetic restoration. This study examines how software-based presurgical simulation affects device selection and device development. Methods: Based on videofluoroscopic motion recordings and pixel-precise processing of the segmental motion patterns, a software-based surrogate functional model was validated. It characterizes the individual movement of spinal segments relative to corresponding cervical or lumbar spine sections. The single segment-based motion of cervical or lumbar spine of individual patients can be simulated, if size-calibrated functional X-rays of the relevant spine section are available. The software plug-in "biokinemetric triangle" has been then integrated into this software to perform comparative segmental motion analyses before and after treatment in two cervical device studies: the correlation of implant-induced changes in the movement geometry and patient-related outcome was examined to investigate, whether this surrogate model could provide a guideline for implant selection and future implant development. Results: For its validation in 253 randomly selected patients requiring single-level cervical (n=122) or lumbar (n=131) implant-supported restoration, the biokinemetric triangle provided significant pattern recognition in comparable investigations (p<0.05) and the software detected device-specific changes after implant-treatment (p<0.01). Subsequently, 104 patients, who underwent cervical discectomy, showed a correlation of the neck disability index with implant-specific changes in their segmental movement geometry: the preoperative simulation supported the best choice of surgical implants, since the best outcome resulted from restricting the extent of the movement of adjacent segments influenced by the technical mechanism of the respective device (p<0.05). Conclusions: The implant restoration resulted in best outcome which modified intersegmental communication in a way that the segments adjacent to the implanted segment undergo less change in their own movement geometry. Based on our software-surrogate, individualized devices could be created that slow down further degeneration of adjacent segments by influencing the intersegmental communication of the motion segments. Competing Interests: Competing interests: Authors state no conflict of interest. (© 2021 Monique Salchow-Gille et al., published by De Gruyter, Berlin/Boston.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu