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dc.contributor.author
Senteler, Marco
dc.contributor.author
Weisse, Bernhard
dc.contributor.author
Snedeker, Jess Gerrit
dc.contributor.author
Rothenfluh, Dominique A.
dc.date.accessioned
2021-05-05T14:29:15Z
dc.date.available
2017-06-11T11:22:37Z
dc.date.available
2021-05-05T14:29:15Z
dc.date.issued
2014-07
dc.identifier.issn
0940-6719
dc.identifier.issn
1432-0932
dc.identifier.other
10.1007/s00586-013-3132-7
en_US
dc.identifier.uri
http://hdl.handle.net/20.500.11850/87126
dc.identifier.doi
10.3929/ethz-b-000087126
dc.description.abstract
Purpose Symptomatic adjacent segment disease (ASD) has been reported to occur in up to 27 % of lumbar fusion patients. A previous study identified patients at risk according to the difference of pelvic incidence and lordosis. Patients with a difference between pelvic incidence and lumbar lordosis >15° have been found to have a 20 times higher risk for ASD. Therefore, it was the aim of the present study to investigate forces acting on the adjacent segment in relation to pelvic incidence–lumbar lordosis (PILL) mismatch as a measure of spino-pelvic alignment using rigid body modeling to decipher the underlying forces as potential contributors to degeneration of the adjacent segment. Methods Sagittal configurations of 81 subjects were reconstructed in a musculoskeletal simulation environment. Lumbar spine height was normalized, and body and segmental mass properties were kept constant throughout the population to isolate the effect of sagittal alignment. A uniform forward/backward flexion movement (0°–30°–0°) was simulated for all subjects. Intervertebral joint loads at lumbar level L3–L4 and L4–L5 were determined before and after simulated fusion. Results In the unfused state, an approximately linear relationship between sagittal alignment and intervertebral loads could be established (shear: 0° flexion r = 0.36, p < 0.001, 30° flexion r = 0.48, p < 0.001; compression: 0° flexion r = 0.29, p < 0.01, 30° flexion r = 0.40, p < 0.001). Additionally, shear changes during the transition from upright to 30° flexed posture were on average 32 % higher at level L3–L4 and 14 % higher at level L4–L5 in alignments that were clinically observed to be prone to ASD. Simulated fusion affected shear forces at the level L3–L4 by 15 % (L4–L5 fusion) and 23 % (L4–S1 fusion) more for alignments at risk for ASD. Conclusion Higher adjacent segment shear forces in alignments at risk for ASD already prior to fusion provide a mechanistic explanation for the clinically observed correlation between PILL mismatch and rate of adjacent segment degeneration.
en_US
dc.format
application/pdf
en_US
dc.language.iso
en
en_US
dc.publisher
Springer
en_US
dc.rights.uri
http://rightsstatements.org/page/InC-NC/1.0/
dc.subject
Musculoskeletal modeling
en_US
dc.subject
Spino-pelvic alignment
en_US
dc.subject
Lumbar fusion
en_US
dc.subject
Shear
en_US
dc.subject
Intervertebral disc degeneration
en_US
dc.subject
Adjacent segment degeneration
en_US
dc.title
Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine
en_US
dc.type
Journal Article
dc.rights.license
In Copyright - Non-Commercial Use Permitted
dc.date.published
2014-03-20
ethz.journal.title
European Spine Journal
ethz.journal.volume
23
en_US
ethz.journal.issue
7
en_US
ethz.journal.abbreviated
Eur Spine J
ethz.pages.start
1384
en_US
ethz.pages.end
1393
en_US
ethz.version.deposit
publishedVersion
en_US
ethz.notes
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
en_US
ethz.identifier.wos
ethz.identifier.nebis
001991155
ethz.publication.place
Berlin
en_US
ethz.publication.status
published
en_US
ethz.leitzahl
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02070 - Dep. Gesundheitswiss. und Technologie / Dep. of Health Sciences and Technology::02518 - Institut für Biomechanik / Institute for Biomechanics::03822 - Snedeker, Jess G. / Snedeker, Jess G.
en_US
ethz.leitzahl.certified
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02070 - Dep. Gesundheitswiss. und Technologie / Dep. of Health Sciences and Technology::02518 - Institut für Biomechanik / Institute for Biomechanics::03822 - Snedeker, Jess G. / Snedeker, Jess G.
ethz.date.deposited
2017-06-11T11:24:03Z
ethz.source
ECIT
ethz.identifier.importid
imp593652218eba372511
ethz.ecitpid
pub:137188
ethz.eth
yes
en_US
ethz.availability
Open access
en_US
ethz.rosetta.installDate
2017-07-20T17:50:32Z
ethz.rosetta.lastUpdated
2024-02-02T13:37:52Z
ethz.rosetta.versionExported
true
ethz.COinS
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