The effect of dynamic posterior stabilization on facet joint contact forces: an in vitro investigation

Abstract

Study design: Facet contact forces in the lumbar spine were measured during flexibility tests using thin film electroresistive sensors in intact cadaveric spine specimens and in injured specimens stabilized with a dynamic posterior system.

Objective: The purpose of this study was to investigate the effect of the Dynesys system on the loading in the facet joints.

Summary of background data: The Dynesys, a posterior nonfusion device, aims to preserve intersegmental kinematics and reduce facet loads. Recent biomechanical evidence showed that overall motion is less with the Dynesys than in the intact spine, but no studies have shown its effect on facet loads.

Methods: Ten human cadaveric lumbar spine specimens (L2-L5) were tested by applying a pure moment of +/-7.5 N m in 3 directions of loading with and without a follower preload of 600 N. Test conditions included an intact specimen and an injured specimen stabilized with 3 Dynesys spacer lengths. Bilateral facet contact forces were measured during flexibility tests using thin film electroresistive sensors (Tekscan 6900).

Results: Implanting the Dynesys significantly increased peak facet contact forces in flexion (from 3 N to 22 N per side) and lateral bending (from 14 N to 24 N per side), but had no significant effect on the magnitude of the peak forces in extension and axial rotation. Peak facet loads were significantly lower with the long spacer compared with the short spacer in flexion and lateral bending.

Conclusion: Implantation of the Dynesys did not affect peak facet contact forces in extension or axial rotation compared with an intact specimen, but did alter these loads in flexion and lateral bending. The spacer length affected the compression of the posterior elements, with a shorter spacer typically producing greater facets loads than a longer one.