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Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.
Jianqiang Mo1, Wen Zhang1, Dongyan Zhong1
1Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, People's Republic of China.
Plos One
|February 27, 2016
Summary
Preventative long-segment surgery is not necessary for multi-level spondylolysis. Posterior lumbar interbody fusion (PLIF) does not significantly alter biomechanics at adjacent segments with pars defects.
Area of Science:
- Spine biomechanics
- Surgical outcomes
- Spinal fusion
Background:
- Multi-level spondylolysis often involves prophylactic fixation of asymptomatic segments.
- The necessity of extending fusion to non-defective, asymptomatic segments remains debated.
Purpose of the Study:
- To biomechanically evaluate the necessity of preventative long-segment surgery in multi-level spondylolysis.
- To assess the impact of posterior lumbar interbody fusion (PLIF) on adjacent segments with pars defects.
Main Methods:
- A bi-level spondylolysis model with L4-L5 pars defects was created.
- Simulated PLIF and pedicle screw fixation at L5-S1.
- Compared biomechanical changes at the L4 segment pre- and post-surgery under various loading conditions.
Main Results:
- L4 pars interarticularis stress remained similar post-surgery, peaking during axial rotation.
- Intradiscal pressures at L3-L4 and L4-L5 showed minimal changes.
- Range of motion at adjacent levels (L3-L4, L4-L5) increased slightly (approx. 1 degree).
Conclusions:
- PLIF surgery does not induce significant biomechanical alterations in adjacent segments with pars defects in multi-level spondylolysis.
- Excessive long-segment fusion may harm spinal stability by damaging surrounding soft tissues.
- Preventative long-segment surgery is likely unnecessary for asymptomatic adjacent segments.
