Abstract
Aim of many surgical operations on the spine is very often to achieve a solid fusion between two or more vertebrae (arthrodesis). Describing lumbar spine mobility radiographically has been determined to be very imprecise with measurement errors of three to six mm in the sagittal plane. Using roentgen stereophotogrammetric analysis (RSA) it is possible to perform clinical kinematic lumbar studies with high accuracy. Many experimental studies have presented basic data on the stabilising implant effect in human cadaver lumbar spines, but no study compared the in vivo stabilising effect in different types of implant.
The RSA was performed in a radiographic set-up with two 40° angulated roentgen tubes with simultaneous exposures. A combined reference plate and calibration device with 0.8 mm tantalum balls at known positions was situated between the patient and the uniplanar film cassette, enabling simultaneous calibration and patient examination. At each RSA the patients were examined in supine and erect positions without corset. The translatory movements, induced by the change in position, of the 0.8 mm tantalum balls implanted into the fused vertebrae were calculated by computed data processing. These translations visualised the movements of the most proximal vertebra of the fusion in relation to the most distal.
The present study has demonstrated the in vivo stability of lumbar fusion augmented with transpedicular screws to be adequate. Sagittal translation seems to be easier to elicit than movements along the other three-dimensional axes. A widely decompressed and destabilised vertebra without screw fixation increases the risk for persisting intervertebral translations. The RSA technique described seems to be a good way for comparing the in vivo behaviour of different implant systems
