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Background Context: Transforaminal endoscopic decompression is an emerging minimally invasive surgical technique in spine surgery. The biomechanical effects and limitations of resections associated with this technique are scarce. Purpose: The objective of this study was to analyze the effects of three different extents of reduction at the craniomedial pedicle (10%, 25%, and 50%) and to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle after reduction was investigated. Study Design: Biomechanical cadaveric study. Methods: Thirty lumbar vertebrae originating from six fresh frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the reduced pedicle on one side, and (2) the native pedicle on the other side. Of the 30 lumbar vertebrae, ten were assigned to each reduction group (10%, 25%, and 50%). Results: On the intact side, the median axial compression force to failure was 593 N (442.4–785.8). A reduction of the pedicle by 10% of the cross-sectional area resulted in a decrease of the axial load resistance by 4% to 66% compared to the intact opposite side (p=.046). The median compression force to failure was 381.89 N (range: 336–662.1). A reduction by 25% resulted in a decrease of 7% to 71% (p=.001). The median compression force to failure was 333 N (265.1–397.3). A reduction by 50% resulted in a decrease of 39% to 90% (p, The Spine Journal, 23 (7), ISSN:1529-9430, ISSN:1878-1632

The ligamentum flavum (LF), the inter- and supraspinous ligament (ISLSSL) and the intertransverse ligament (ITL) are relevant spinal structures for segmental stability. The biomechanical effect of degeneration and aging on their biomechanical properties remains largely unknown.The aim of this study was to assess the material properties of the ITL, ISLSSL and LF and to correlate parameters of biomechanical function with LF-thickness, intervertebral disc (IVD) degeneration and age.Biomechanical cadaveric study.MRI- and CT-scans of 50 human lumbar segments (Th12-L5) were used to assess the ISL (acc. to Keorochana), the grade of IVD degeneration (acc. to Pfirrmann) and to quantify LF-thickness. The ITL, ISLSSL and LF were resected in the neutral position of the spinal segment with a specifically developed method to conserve initial strain. Ramp to failure testing was performed (0.5 mm/s) to record initial tension, slack length, stiffness and ultimate strength. The relationship between the biomechanical characteristics and age and radiological parameters were analyzed. There are no study-specific conflicts of interest and no external funding was received for this study.With aging, a significant reduction in initial tension (r=-0.5, p.01) and ultimate strength (r=-0.41, p.01) of the LF was observed, while the effect on LF-stiffness and the characteristics of the other ligaments was non-significant. IVD-degeneration was correlated with a significant reduction in stiffness (r=-0.47, p=.001; r=-0.36, p=.01) and ultimate strength (r=-0.3, p=.04; r=-0.36, p=.01) of the LF and ISLSSL respectively and a significant reduction in initial tension (r=-0.4, p.01) of the LF. For the ITL, no significant correlation was observed. Comparing Pfirrman 2 to 5, this reduction was 40% to 80% for stiffness 60% to 70% for ultimate strength and 88% for initial tension of the LF. ISLSSL-stiffness between Kerorochana grade A and D differed significantly (p=.03), while all other comparisons were non-significant (p.05). LF-thickness did not correlate with the biomechanical properties of the LF (p.05).Aging is primarily related to biomechanical changes to the LF. IVD-degeneration is related to a relevant reduction in stiffness and ultimate strength of the LF and ISLSSL, with a similar trend for the ITL. The ISL-specific Keorochana grading system provides only minimal biomechanical information and LF-thickness does not provide biomechanical information.Patient age and the degenerative state of the IVD can be used to evaluate the biomechanical characteristics of the dorsal spinal ligaments, which can be helpful in selecting the optimal surgical procedure (e.g. in decompression surgery) for a specific situation.

Background Context The contribution of anatomical structures to the stability of the spine is of great relevance for diagnostic, prognostic and therapeutic evaluation of spinal pathologies. Although a plethora of literature is available, the contribution of anatomical structures is still not well understood. Purpose We aimed to quantify the biomechanical relevance of each of the passive spinal structure trough deliberate biomechanical test series using a stepwise reduction approach on cadavers. Study design Biomechanical cadaveric study. Methods Fifty lumbar spinal segments originating from 22 human lumbar cadavers were biomechanically tested in a displacement-controlled stepwise reduction study: the intertransverse ligaments, the supraspinous and interspinous ligaments, the facet joint capsules (FJC), the facet joints (FJ), the ligamentum flavum (LF), the posterior longitudinal ligament (PLL), and the anterior longitudinal ligament were subsequently reduced. In the intact state and after each transection step, the segments were physiologically loaded in flexion, extension, axial rotation (AR), lateral bending (LB) and with anterior (AS), posterior (PS) and lateral shear (LS). Thirty-two specimens with only minor degeneration, representing a reasonably healthy subpopulation, were selected for the here presented evaluation. Quantitative values for load and spinal level dependent contribution patterns for the anatomical structures were derived. Results Small variability between of the contribution patterns are observed. The intervertebral disc (IVD) is exposed to about 67% of the applied load in LB and during shear loading, but less by load in flexion, extension and AR (less than 35%). The FJ&FJC are the main stabilizers in AR with 49%, but provide only 10% of the stability in extension. Beside the IVD, the LF and the PLL contribute mainly in flexion (22% and 16%, respectively), while the ALL plays a major role during extension (40%) and also contributes during LB (15%). The contribution of the intertransverse ligaments and the supraspinous and interspinous ligaments are very small in all loading directions ( Conclusion The IVD takes the main load in LB and absorbs shear loading, while the FJ&FJC stabilize AR. The ALL resists extension while LF and PLL stabilize flexion. With the small variability of contribution patterns, suggesting distinct adaptation of the structures to one another, the biomechanical characteristics of one structure have to be put in context of the whole spinal segment. CLINICAL SIGNIFICANCE The novel information on load distribution helps predict the biomechanical consequences of surgical procedures in more detail.

3D printed clamps provide multiple advantages compared to potting for the fixation of spinal specimens and in a recent study, superior fixation stability was reported. The aim of this study was to evaluate the fixation efficacy of 3D printed vertebra clamps during routine application and to present and evaluate a novel clamp for sacrum fixation. Further, public access to the template files is provided. 98 human single-level cadaveric specimens were biomechanically tested in flexion-extension (FE), lateral bending (LB), axial rotation (AR), anteroposterior shear (AS), lateral shear (LS) and axial compression-decompression (AC). Loading amplitudes were +/-7.5 Nm for FE, LB and AR, +/- 150 N for AS and LS and + 400/-100 N for AC. The novel sacrum clamp was used in 8 specimens. The median relative motion between clamps and specimens was 0.6 degrees in FE, 0.7 degrees in LB, 0.3 degrees in AR, 0.5 mm in AS, 0.5 mm in LS and 0.1 mm in AC. With sacrum clamps, the median relative motion was 0.3 degrees in FE, 0.1 degrees in LB, 0.08 degrees in AR, 0.8 mm in AS, 0.7 mm in LS and 0.2 mm in AC. The vertebra clamps used during routine testing provided better stability compared to the values in the literature in all six loading directions (p < 0.05). The sacrum clamp showed superior anchoring stability in three loading directions compared to the caudal vertebra clamps (p < 0.05), while inferior stability was measured in AS (p < 0.001). We conclude that 3D printed vertebra clamps and 3D printed sacrum clamps represent reliable methods for specimen fixation during routine biomechanical testing., Journal of Biomechanics, 125, ISSN:0021-9290, ISSN:1873-2380

This study presents an anatomically customizable fixation technique for biomechanical spine experiments using a 3D printed clamping system. The aim of this study is to evaluate the feasibility and compare the fixation rigidity of the novel technique to PMMA potting with and without screw augmentation. For this purpose, 16 thoracic and lumbar functional spine units of bovine, porcine, ovine and human cadavers (4 each) were consecutively fixed with all three techniques and loaded in six degrees of freedom. The combined relative movement between the cranial and caudal vertebral body and their corresponding fixtures were recorded using a 3D motion capture system. The 3D printed clamps did provide multiple advantages, showed no failures and the fixation rigidity was superior to potting in all loading directions and superior to screw-augmented potting in two of six loading directions (p