• Yann Philippe Charles, Lucas Venancio Pires Carvalho Lima, Sylvain Persohn, Philippe Rouch, Jean-Paul Steib, and Wafa Skalli.
• Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris, France; Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle, Université de Strasbourg, 1, Place de l'hôpital, B.P. 426, 67091 Strasbourg Cedex, France. Electronic address: yann.philippe.charles@chru-strasbourg.fr.
• Spine J. 2013 Oct 1; 13 (10): 1293-300.

Background ContextFacet supplementation stabilizes after facetectomy and undercutting laminectomy. It is indicated in degenerative spondylolisthesis with moderate disc degeneration and dynamic stenosis.PurposeTo determine the influence of an auxiliary facet system (AFS) on the instrumented disc, adjacent levels' discs, and facet joints and to compare it with fusion.Study DesignFinite element study.MethodsL3-L4, L4-L5, and L5-S1 were studied using a validated finite element model with prescribed displacements for an intact spine, lesion by facetectomy and undercutting laminectomy, AFS, and fusion at L4-L5. The distribution of segmental range of motion (ROM) and applied moments, von Mises stress at the annulus, and facet joint contact forces were calculated with rotations in all planes. Institutional support for implant evaluation and modeling was received by Clariance.ResultsIn flexion-extension and lateral bending, fusion decreased L4-L5 ROM and increased adjacent levels' ROM. Range of motion was similarly distributed with intact lesion and AFS. In axial rotation, L4-L5 ROM represented 33% with intact, 55% after lesion, 25% with AFS, and 21% with fusion. Fusion increased annulus stress at adjacent levels in flexion-extension and lateral bending, but decreased stress at L4-L5 compared with AFS. In axial rotation, von Mises stress was similar with fusion and AFS. Facet loading increased in extension and lateral bending with fusion. It was comparable for fusion and AFS in axial rotation.ConclusionsThis study suggests that the AFS stabilizes L4-L5 in axial rotation after facetectomy and undercutting laminectomy as fusion does. This is because of the cross-link that generates an increased annulus stress in axial rotation at adjacent levels. With imposed displacements, without in vivo compensation of the hips, the solicitation at adjacent levels' discs and facet joints is higher with fusion compared with AFS. Fusion decreases intradiscal stress at the instrumented level.Copyright © 2013 Elsevier Inc. All rights reserved.

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