Spine stability after implantation of an interspinous device: An in vitro and finite element biomechanical study - Laboratory investigation

Object. Interspinous devices are widely used for the treatment of lumbar stenosis. The DIAM spinal stabilization system (Medtronic, Ltd.) is an interspinous implant made of silicone and secured in place with 2 laces. The device can be implanted via posterior access with the sacrifice of the supraspinous ligament (SSL) or via lateral access with preservation of the ligament. The aim of the present work was to evaluate the role of the laces, the SSL, and the device size and positioning to determine the device's ability in reducing segmental lordosis and in stabilizing motion. Methods. Biomechanical tests were performed in flexion and extension on 8 porcine spines implanted with the DIAM either with or without the laces and the SSL. A finite element model of the human L4-5 spine segments was also created and used to test 2 sizes of the device implanted in 2 different positions in the anteroposterior direction. Results. Implantation of the DIAM induced a shift toward kyphosis in the neutral position. Laces, the SSL, and device size and placement had a significant influence on the neutral position, the stiffness of the implanted spine, and the positions of the instantaneous centers of rotation. Conclusions. The shift of the neutral position toward kyphosis may be beneficial in reducing symptoms of spinal stenosis such as radicular pain, sensation disturbance, and loss of strength in the legs. The authors recommend preservation of the SSL and the use of the fixation laces, given their relevant mechanical role. Choosing the proper device size and placement should be achieved by using a correct surgical technique.