Chapter 6: Conclusion and future work
6.2 Future work
There are several topics can be extended for the non-fusion surgery combined with Coflex device.
The above studies are focused in single segment disease only. However, the disc
degeneration disease occurs sometime in the multi-segment or adjacent segment after fusion surgery. Adjacent segment degeneration is the tendency for clinical symptomatic changes to occur following fusion surgery. It is widely believed that spinal fusion significantly alters the biomechanical environment of the adjacent spinal motion segments leading to an acceleration of the normal degenerative process. Little et al. [108] reported the effect of anterior interbody fixation on facet capsule strains. Seven cadaveric lumbar spine specimens were evaluated during physiological motion in the intact state and following anterior interbody fusion. The reduction of motion induced by interbody fusion resulted in increased facet joint capsule strain at the adjacent segments. Weinhoffer et al. [109] investigated the intradiscal pressure changes occurring following instrumented lumbar fusion in a biomechanical study. Pressure transducers measured intradiscal pressures at L3-L4 and L4-L5 in intact specimens and following L5-S1 fusion. Pressure measurements were significantly increased following fusion.
Additionally, as the number of fusion segments was increased, there was a corresponding increase in intradiscal pressure ate the adjacent segment.
Therefore, for non-fusion surgery, one of the proposed study is going to compare the biomechanical characteristic of two-segment Coflex or Coflex-F implant and a hybrid implant (one-segment Coflex or Coflex-F and one-segment pedicle screw fixation) in the further.
There are also topics can be extended for the fusion surgery combined with Coflex-F device. Our existing studies used specific cage (semilunar cage) for minimally invasive transforaminal lumbar interbody fusion. Currently, many kinds of cage designs are available on the market, which can be classified by the various geometry, size and material. Cho et al.
[110] compare three TLIF implant designs (Stryker AVS PL, AVS TL and the Medtronic Capstone) with different lengths and shapes (flat or biconvex, straight or banana shape) in terms of biomechanical stability on human cadaveric models. The results showed that the geometry of cages, including shape (banana or straight), length, surface profile (biconvex or flat), did not affect construct stability when the cages were used in conjunction with pedicle
88
screw fixation.
However, the relationship between the geometry of cage, the positions of cage insertion and the use of Coflex-F device are unknown. Therefore, the study concerning the fusion surgery combined with Coflex-F device can be focused on different kind cage together with different insert positions for TLIF in the further.
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Conference Papers
International Conference Paper
1. Cheng-Chan Lo, Kai-Jow Tsai, Zheng-Cheng Zhong, Chinghua Hung. “Biomechanical behavior between Prodisc-L and Physio-L in total disc replacement”, ISTA2010, the 23rd Annual Congress of the International Society for Technology in Arthroplasty. Dubai, United Arab Emirates. October 6-9, 2010.
2. Cheng-Chan Lo, Kai-Jow Tsai, Zheng-Cheng Zhong, Chinghua Hung. “Biomechanical characteristic of Coflex-F and pedicle screw fixation with TLIF or ALIF surgery - A finite element study”, WCB2010, 6th World Congress on Biomechanics. Suntec Singapore International Convention & Exhibition Centre, Singapore. August 1 - 6, 2010.
3. Kai-Jow Tsai, Cheng-Chan Lo, Chinghua Hung. “Biomechanical effect of interspinous process decompression device (Coflex) for multilevel lumbar spinal stenosis”, World Forum for Spine Research 2010 - The Intervertebral Disc. Montreal, Canada. July 5 - 8, 2010.
4. Cheng-Chan Lo, Zheng-Cheng Zhong, Shih-Hao Chen, Ming-Chieh Chiang, Chinghua Hung. “Biomechanical effect of TLIF combined with Coflex-F or with unilateral pedicle screw fixation for minimally invasive surgery - A finite element study”, ESB2010, 17th Congress of the European Society of Biomechanics. University of Edinburgh, UK. July 5 - 8, 2010.
5. Cheng-Chan Lo, Zheng-Cheng Zhong, Shih-Hao Chen, Ming-Chieh Chiang, Chinghua Hung. “Biomechanical effect after interspinous process device (Coflex) implantation for multilevel decompression surgery - A finite element study”, ESB2010, 17th Congress of the European Society of Biomechanics. University of Edinburgh, UK. July 5 - 8, 2010.
6. Cheng-Chan Lo, Zheng-Cheng Zhong, Chinghua Hung. “Biomechanical differences between Coflex-F and traditional pedicle screw fixation on fusion surgery - A Finite Element Study”, ISTA 2009, the 22nd Annual Congress of the International Society for
6. Cheng-Chan Lo, Zheng-Cheng Zhong, Chinghua Hung. “Biomechanical differences between Coflex-F and traditional pedicle screw fixation on fusion surgery - A Finite Element Study”, ISTA 2009, the 22nd Annual Congress of the International Society for