Several clinical studies demonstrated long-term adjacent-level effects after implantation of spinal fusion devices[1]. These effects have been reported as adjacent joint degeneration and the development of new symptoms correlating with adjacent segment degeneration[2] and the trend has therefore gone to motion preservation devices; however, these effects have not been understood very well and have not been investigated thoroughly[3]. The aim of this study is to investigate the effect of varying the stiffness of spinal fusion devices on the adjacent vertebral levels. Disc forces, moments and facet joint forces were analyzed. The AnyBody Modeling System was used to compute the in-vivo muscle and joint reaction forces of a musculoskeletal model. The full body model used in this study consists of 188 muscle fascicles in the lumbar spine and more than 1000 individual muscle branches in total. The model has been proposed by de Zee et al.[3], validated by Rasmussen et al.[4] and by Galibarov et al.[5]. The new model[5] determines the individual motions between vertebrae based on the equilibrium between forces acting on the vertebrae from muscles and joints and the passive stiffness in disks and ligaments, figure 1a. An adult of 1.75 m and 75 kg with a spinal implant in L4L5 was modeled. This model was subjected to a flexion-extension motion using different elastic moduli to analyze and compare to a non-implanted scenario. The analyzed variables were vertebral motion, the disc reaction forces and moments, as well as facet joint forces in the treated and the adjacent levels: L2L3, L3L4, L4L5 and L5-Sacrum.INTRODUCTION
METHODS
