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Biomechanics of high-grade spondylolisthesis with and without reduction

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Abstract

The clinical advantages of reducing spondylolisthesis over fusion in situ have several intuitive reasons such as restore the spinal column into a more anatomic relationship and alignment. However, there is only little evidence in the literature supporting the theoretical advantages of reduction, and its effect on spinopelvic alignment remains poorly defined. In this study, a comprehensive finite element model was developed to analyze the biomechanics of the spine after spinal fusion at L5–S1 in both types of high-grade spondylolisthesis (balanced and unbalanced pelvis). The relevant clinical indices (i.e. spondylolisthesis grade and Dubousset lumbosacral angle), the displacement of L4–L5, pressure within the annulus and nucleus, and stress at L4–L5 were evaluated and compared. The model can well predict the changes of the important clinical indices during the surgery. For a balanced pelvis, the reduction has a minimal effect on the biomechanical conditions at the adjacent level during postsurgical activities. In the unbalanced case, reduction induced larger deformation in the lumbosacral region and a higher stress concentration at adjacent level. Whether such a stress concentration can lead to long-term disc degeneration is not known. The results provide additional information for the clinician considering reduction of high-grade spondylolisthesis.

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Acknowledgments

This study was funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada) and a research scholarship from Shriners Hospitals for Children.

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Authors and Affiliations

  1. Sainte-Justine University Hospital Center (University of Montreal), 3175 Côte-Ste-Catherine Rd., Montreal, QC, H3T 1C5, Canada

    Wenhai Wang, Carl-Eric Aubin, Stefan Parent & Hubert Labelle

  2. Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Station “Centre-ville”, Montreal, QC, H3C 3A7, Canada

    Carl-Eric Aubin

  3. College of Engineering, Temple University, 1947N 12th Street, Philadelphia, PA, 19122, USA

    Wenhai Wang & George Baran

  4. Shriners Hospitals for Children–Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA

    Patrick Cahill

  5. Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille Université, Boulevard Pierre Dramard, 13916, Marseille Cedex 20, France

    Pierre-Jean Arnoux

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  1. Wenhai Wang
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  2. Carl-Eric Aubin
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  7. Hubert Labelle
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Correspondence to Carl-Eric Aubin.

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Wang, W., Aubin, CE., Cahill, P. et al. Biomechanics of high-grade spondylolisthesis with and without reduction. Med Biol Eng Comput 54, 619–628 (2016). https://doi.org/10.1007/s11517-015-1353-0

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  • DOI: https://doi.org/10.1007/s11517-015-1353-0

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