Evaluation clinique et biomécanique d'un implant de stabilisation dynamique du rachis lombaire

Abstract : Back pain is one of the first causes of surgical intervention in the world and instrumentation is needed for about 1 patient out of 100 . Fusion is the gold standard for instrumented surgery and consists in fixation of two adjacent vertebra together with pedicular screws and rigid rods. Clinical outcomes of fusion are satisfactory but some cases of adverse events remain such as adjacent segment degeneration sometimes leading to revision surgery. Dynamic stabilization devices have been proposed to tackle this issue with the objective of maintaining motion at the instrumented level and thus limiting the surrounding structure overloading. This work aims at assessing one dynamic stabilization device. We first performed mechanical testing on the device to better understand its functioning and come up with a detailed and validated model. Then a retrospective clinical work has been conducted to lay out the clinical performances of the device and propose a prospective study design to answer clinical and scientific requirements. A biomechanical in-vitro testing campaign has been set up to increase our knowledge about the behaviour of the instrumented spine. This enabled us to validate a finite elements model then used for the study of the influence of several design parameters but also of several choices made during the surgery.
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Marion Prud'Homme. Evaluation clinique et biomécanique d'un implant de stabilisation dynamique du rachis lombaire. Biomécanique [physics.med-ph]. Ecole nationale supérieure d'arts et métiers - ENSAM, 2014. Français. ⟨NNT : 2014ENAM0066⟩. ⟨tel-01127529⟩

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