{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:53:43Z","timestamp":1768262023582,"version":"3.49.0"},"reference-count":89,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Medical Hypotheses"],"published-print":{"date-parts":[[2020,11]]},"DOI":"10.1016\/j.mehy.2020.109900","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T11:34:59Z","timestamp":1591270499000},"page":"109900","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"special_numbering":"C","title":["A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery?"],"prefix":"10.1016","volume":"144","author":[{"given":"Lei","family":"Dang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinglin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongjun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoguang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunli","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0005","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/00007632-198504000-00016","article-title":"Physical signs of instability","volume":"10","author":"Paris","year":"1985","journal-title":"Spine"},{"key":"10.1016\/j.mehy.2020.109900_b0010","unstructured":"Jurek S, Rao RD. Cervical spondylosis: pathophysiology, natural history, and clinical syndromes of neck pain, radiculopathy, and myelopathy. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. Rothman-Simeone The Spine. 1. philadelphia: Elsevier Inc.; 2011. p. 688."},{"key":"10.1016\/j.mehy.2020.109900_b0015","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1471-2474-15-50","article-title":"A systematic review and meta-synthesis of the impact of low back pain on people's lives","volume":"15","author":"Froud","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0020","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/BRS.0000000000001665","article-title":"Behavior-related factors associated with low back pain in the US adult population","volume":"43","author":"Yang","year":"2018","journal-title":"Spine"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0025","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S1050-6411(03)00044-0","article-title":"Clinical spinal instability and low back pain","volume":"13","author":"Panjabi","year":"2003","journal-title":"J Electromyogr Kinesiol"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0030","doi-asserted-by":"crossref","first-page":"262","DOI":"10.2519\/jospt.2014.4988","article-title":"Clinical observation of standing trunk movements: what do the aberrant movement patterns tell us?","volume":"44","author":"Biely","year":"2014","journal-title":"J Orthop Sports Phys Ther"},{"issue":"2","key":"10.1016\/j.mehy.2020.109900_b0035","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2519\/jospt.2013.4310","article-title":"The interrater reliability of physical examination tests that may predict the outcome or suggest the need for lumbar stabilization exercises","volume":"43","author":"Rabin","year":"2013","journal-title":"J Orthop Sports Phys Ther"},{"key":"10.1016\/j.mehy.2020.109900_b0040","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00003086-198205000-00015","article-title":"Instability of the lumbar spine","volume":"165","author":"Kirkaldy-Willis","year":"1982","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0045","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1097\/00007632-198410000-00011","article-title":"The nature of instability","volume":"9","author":"Farfan","year":"1984","journal-title":"Spine"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0050","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.2106\/00004623-198466070-00011","article-title":"Spine radiographs in patients with low-back pain. An epidemiological study in men","volume":"66","author":"Frymoyer","year":"1984","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0055","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ejpain.2005.06.009","article-title":"Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment","volume":"10","author":"Breivik","year":"2006","journal-title":"Eur J Pain"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0060","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1002\/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V","article-title":"Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States","volume":"41","author":"Lawrence","year":"1998","journal-title":"Arthritis Rheum"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0065","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1179\/106698110X12595770849443","article-title":"Lumbar instability: an evolving and challenging concept","volume":"18","author":"Beazell","year":"2010","journal-title":"J Man Manip Ther"},{"key":"10.1016\/j.mehy.2020.109900_b0070","article-title":"Clinical spinal instability: 10 years since the derivation of a clinical prediction rule. A narrative literature review","author":"Mitchell","year":"2018","journal-title":"J Back Musculoskelet Rehabil"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0075","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/foc.2007.22.1.12","article-title":"Clinical application of the Panjabi neutral zone hypothesis: the Stabilimax NZ posterior lumbar dynamic stabilization system","volume":"22","author":"Yue","year":"2007","journal-title":"Neurosurg Focus"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0080","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jmpt.2016.04.003","article-title":"The relationship between clinical instability and endurance tests, pain, and disability in nonspecific low back pain","volume":"39","author":"Vanti","year":"2016","journal-title":"J Manipulative Physiol Ther"},{"issue":"6","key":"10.1016\/j.mehy.2020.109900_b0085","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/BF00426175","article-title":"Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain","volume":"113","author":"Murata","year":"1994","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0090","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/00007632-198903000-00014","article-title":"Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals","volume":"14","author":"Hayes","year":"1989","journal-title":"Spine"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0095","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/01.bsd.0000102473.95064.9d","article-title":"Lumbar instability and clinical symptoms: which is the more critical factor for symptoms: sagittal translation or segment angulation?","volume":"17","author":"Iguchi","year":"2004","journal-title":"J Spinal Disord Tech"},{"issue":"18","key":"10.1016\/j.mehy.2020.109900_b0100","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1097\/01.brs.0000231435.55842.9e","article-title":"Three-dimensional in vivo measurement of lumbar spine segmental motion","volume":"31","author":"Ochia","year":"2006","journal-title":"Spine"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0105","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/00007632-199301000-00018","article-title":"Clinical validation of functional flexion\/extension radiographs of the cervical spine","volume":"18","author":"Dvor\u00e1k","year":"1993","journal-title":"Spine"},{"issue":"9","key":"10.1016\/j.mehy.2020.109900_b0110","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1097\/00007632-199505000-00010","article-title":"A database for estimating normal spinal motion derived from noninvasive measurements","volume":"20","author":"Gracovetsky","year":"1995","journal-title":"Spine"},{"issue":"Suppl 2","key":"10.1016\/j.mehy.2020.109900_b0115","doi-asserted-by":"crossref","first-page":"S198","DOI":"10.1007\/s00586-002-0422-x","article-title":"Rationale, principles and experimental evaluation of the concept of soft stabilization","volume":"11","author":"Mulholland","year":"2002","journal-title":"Eur Spine J"},{"issue":"Suppl 7","key":"10.1016\/j.mehy.2020.109900_b0120","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00586-015-4274-6","article-title":"Lumbar spinal degenerative \u201cmicroinstability\u201d: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment","volume":"24","author":"Landi","year":"2015","journal-title":"Eur Spine J"},{"issue":"8","key":"10.1016\/j.mehy.2020.109900_b0125","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1136\/annrheumdis-2015-207317","article-title":"From Modic 1 vertebral-endplate subchondral bone signal changes detected by MRI to the concept of 'active discopathy'","volume":"74","author":"Nguyen","year":"2015","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0130","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/00002517-199212000-00001","article-title":"The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement","volume":"5","author":"Panjabi","year":"1992","journal-title":"J Spinal Disord"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0135","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1097\/00007632-199107000-00018","article-title":"The intersegmental and multisegmental muscles of the lumbar spine: a biomechanical model comparing lateral stabilizing potential","volume":"16","author":"Crisco","year":"1991","journal-title":"Spine"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0140","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1097\/00007632-200204010-00005","article-title":"Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine","volume":"27","author":"Boyd-Clark","year":"2002","journal-title":"Spine"},{"issue":"8","key":"10.1016\/j.mehy.2020.109900_b0145","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1097\/01.BRS.0000058937.12688.A1","article-title":"Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain","volume":"28","author":"Leinonen","year":"2003","journal-title":"Spine"},{"issue":"8","key":"10.1016\/j.mehy.2020.109900_b0150","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1097\/00007632-200004150-00015","article-title":"The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain","volume":"25","author":"Brumagne","year":"2000","journal-title":"Spine"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0155","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1007\/s005860000190","article-title":"CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects","volume":"9","author":"Danneels","year":"2000","journal-title":"Eur Spine J"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0160","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s00586-009-1257-5","article-title":"Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study","volume":"19","author":"Kalichman","year":"2010","journal-title":"Eur Spine J"},{"key":"10.1016\/j.mehy.2020.109900_b0165","doi-asserted-by":"crossref","unstructured":"Andersson GBJ, Biyani A, Ericksen ST. Lumbar disc disease. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. Rothman-Simeone The Spine. 1. 6th ed. Philadelphia: Elsevier Inc.; 2011. p. 846.","DOI":"10.1016\/B978-1-4160-6726-9.00045-6"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0170","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2015.7.FOCUS15278","article-title":"Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature","volume":"39","author":"Joseph","year":"2015","journal-title":"Neurosurg Focus"},{"issue":"10","key":"10.1016\/j.mehy.2020.109900_b0175","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.spinee.2017.04.022","article-title":"Lateral lumbar interbody fusion: a systematic review of complication rates","volume":"17","author":"Hijji","year":"2017","journal-title":"Spine J"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0180","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1007\/s00586-016-4415-6","article-title":"Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis","volume":"25","author":"Pan","year":"2016","journal-title":"Eur Spine J"},{"issue":"2","key":"10.1016\/j.mehy.2020.109900_b0185","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.nic.2014.01.008","article-title":"Motion preservation surgery in the spine","volume":"24","author":"Murtagh","year":"2014","journal-title":"Neuroimaging Clin N Am"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0190","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s00590-017-2052-3","article-title":"Spinal motion preservation surgery: indications and applications","volume":"28","author":"Gelalis","year":"2018","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"Suppl 3","key":"10.1016\/j.mehy.2020.109900_b0195","first-page":"S324","article-title":"Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility","volume":"23","author":"Galbusera","year":"2014","journal-title":"Eur Spine J"},{"issue":"10","key":"10.1016\/j.mehy.2020.109900_b0200","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0186779","article-title":"Substantial vertebral body osteophytes protect against severe vertebral fractures in compression","volume":"12","author":"Wagnac","year":"2017","journal-title":"PLoS ONE"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0205","first-page":"842","article-title":"The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey","volume":"26","author":"O'Neill","year":"1999","journal-title":"J Rheumatol"},{"issue":"2","key":"10.1016\/j.mehy.2020.109900_b0210","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00007611-199802000-00012","article-title":"Morphologic study of lumbar vertebral osteophytes","volume":"91","author":"Heggeness","year":"1998","journal-title":"South Med J"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0215","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1002\/art.1780230309","article-title":"Vertebral osteophyte formation in experimental disc degeneration. Morphologic and proteoglycan changes over time","volume":"23","author":"Lipson","year":"1980","journal-title":"Arthritis Rheum"},{"issue":"14","key":"10.1016\/j.mehy.2020.109900_b0220","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1097\/BRS.0b013e3181a48554","article-title":"Small intestinal submucosa for anular defect closure: long-term response in an in vivo sheep model","volume":"34","author":"Ledet","year":"2009","journal-title":"Spine"},{"issue":"12","key":"10.1016\/j.mehy.2020.109900_b0225","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1016\/j.spinee.2018.07.001","article-title":"The biomechanical influence of anterior vertebral body osteophytes on the lumbar spine: a finite element study","volume":"18","author":"Wang","year":"2018","journal-title":"Spine J"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0230","doi-asserted-by":"crossref","first-page":"663","DOI":"10.2106\/00004623-197153040-00005","article-title":"The traction spur. An indicator of segmental instability","volume":"53","author":"Macnab","year":"1971","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0235","doi-asserted-by":"crossref","first-page":"645","DOI":"10.4184\/asj.2015.9.4.645","article-title":"Low back pain: current surgical approaches","volume":"9","author":"Baliga","year":"2015","journal-title":"Asian Spine J"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0240","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/os.12418","article-title":"Value of CT-guided core needle biopsy in diagnosing spinal lesions: a comparison study","volume":"11","author":"Liang","year":"2019","journal-title":"Orthop Surg"},{"issue":"11","key":"10.1016\/j.mehy.2020.109900_b0245","doi-asserted-by":"crossref","first-page":"979","DOI":"10.2106\/JBJS.18.00746","article-title":"Atypical radiographic features of aggressive vertebral hemangiomas","volume":"101","author":"Wang","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"10.1016\/j.mehy.2020.109900_b0250","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1007\/s00586-009-1061-2","article-title":"Diagnosis of a previously unidentified primary site in patients with spinal metastasis: diagnostic usefulness of laboratory analysis, CT scanning and CT-guided biopsy","volume":"18","author":"Iizuka","year":"2009","journal-title":"Eur Spine J"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0255","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.3171\/2016.8.FOCUS16112","article-title":"Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis","volume":"42","author":"Elder","year":"2017","journal-title":"Neurosurg Focus"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0260","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.spinee.2017.08.230","article-title":"Comparison of transforaminal lumbar interbody fusion outcomes in patients receiving rhBMP-2 versus autograft","volume":"18","author":"Khan","year":"2018","journal-title":"Spine J"},{"issue":"6","key":"10.1016\/j.mehy.2020.109900_b0265","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s00264-016-3149-8","article-title":"Bone morphogenetic protein use in spine surgery-complications and outcomes: a systematic review","volume":"40","author":"Faundez","year":"2016","journal-title":"Int Orthop"},{"issue":"6","key":"10.1016\/j.mehy.2020.109900_b0270","doi-asserted-by":"crossref","first-page":"851","DOI":"10.3171\/2014.8.SPINE13524","article-title":"Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications","volume":"21","author":"Malham","year":"2014","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"10.1016\/j.mehy.2020.109900_b0275","doi-asserted-by":"crossref","first-page":"4065","DOI":"10.1002\/art.23034","article-title":"Resemblance of osteophytes in experimental osteoarthritis to transforming growth factor beta-induced osteophytes: limited role of bone morphogenetic protein in early osteoarthritic osteophyte formation","volume":"56","author":"Blaney Davidson","year":"2007","journal-title":"Arthritis Rheum"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0280","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1210\/en.2009-0833","article-title":"High glucose potentiates collagen synthesis and bone morphogenetic protein-2-induced early osteoblast gene expression in rat spinal ligament cells","volume":"151","author":"Li","year":"2010","journal-title":"Endocrinology"},{"key":"10.1016\/j.mehy.2020.109900_b0285","series-title":"OPLL: Ossification of the Posterior Longitudinal Ligament","first-page":"93","article-title":"Experimental Murine Model of Ossification of Spinal Ligaments Induced by Bone Morphogenetic Protein-2","author":"Hoshi","year":"2006"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0290","doi-asserted-by":"crossref","first-page":"157","DOI":"10.5115\/acb.2014.47.3.157","article-title":"Distribution and length of osteophytes in the lumbar vertebrae and risk of rupture of abdominal aortic aneurysms: a study of dry bones from Chiang Mai","volume":"47","author":"Chanapa","year":"2014","journal-title":"Thailand. Anat Cell Biol"},{"key":"10.1016\/j.mehy.2020.109900_b0295","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1471-2474-10-4","article-title":"Direction of the formation of anterior lumbar vertebral osteophytes","volume":"10","author":"Kasai","year":"2009","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0300","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2106\/00004623-197860010-00006","article-title":"Mechanical response of the lumbar intervertebral joint under physiological (complex) loading","volume":"60","author":"Lin","year":"1978","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"10.1016\/j.mehy.2020.109900_b0305","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/00007632-199106000-00008","article-title":"Change of disc height, radial disc bulge, and intradiscal pressure from discectomy an in vitro investigation on human lumbar discs","volume":"16","author":"Brinckmann","year":"1991","journal-title":"Spine"},{"issue":"10","key":"10.1016\/j.mehy.2020.109900_b0310","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1097\/BRS.0b013e3181df1a70","article-title":"Mechanical function of vertebral body osteophytes, as revealed by experiments on cadaveric spines","volume":"36","author":"Al-Rawahi","year":"2011","journal-title":"Spine"},{"issue":"10","key":"10.1016\/j.mehy.2020.109900_b0315","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1136\/ard.2007.085563","article-title":"The effect of alendronate on progression of spinal osteophytes and disc-space narrowing","volume":"67","author":"Neogi","year":"2008","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0320","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S8756-3282(03)00031-0","article-title":"Lack of association between lumbar disc degeneration and osteophyte formation in elderly Japanese women with back pain","volume":"32","author":"Oishi","year":"2003","journal-title":"Bone"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0325","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/01.BRS.0000048650.39042.58","article-title":"Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration","volume":"28","author":"Miyakoshi","year":"2003","journal-title":"Spine"},{"issue":"2","key":"10.1016\/j.mehy.2020.109900_b0330","doi-asserted-by":"crossref","first-page":"243","DOI":"10.2106\/00004623-196244020-00003","article-title":"Osteophytes of the vertebral column: An anatomical study of their development according to age, race and sex with consideration of their aetiology and significance","volume":"44","author":"Nathan","year":"1962","journal-title":"J Bone Joint Surgery-Am"},{"issue":"12","key":"10.1016\/j.mehy.2020.109900_b0335","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1097\/00007632-199406000-00011","article-title":"Discdegeneration affects the multidirectional flexibility of the lumbar spine","volume":"19","author":"Mimura","year":"1994","journal-title":"Spine"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0340","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1038\/nrrheum.2012.199","article-title":"Osteoarthritis of the spine: the facet joints","volume":"9","author":"Gellhorn","year":"2013","journal-title":"Nat Rev Rheumatol"},{"key":"10.1016\/j.mehy.2020.109900_b0345","first-page":"93","article-title":"Transmission of weight through the lower thoracic and lumbar regions of the vertebral column in man","volume":"152","author":"Pal","year":"1987","journal-title":"J Anat"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0350","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/00007632-198304000-00017","article-title":"The mechanical function of the lumbar apophyseal joints","volume":"8","author":"Adams","year":"1983","journal-title":"Spine"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0355","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00007632-199005000-00010","article-title":"The effect of facet geometry on the axial torque-rotation response of lumbar motion segments","volume":"15","author":"Ahmed","year":"1990","journal-title":"Spine"},{"issue":"7","key":"10.1016\/j.mehy.2020.109900_b0360","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/01.bsd.0000211213.98070.c2","article-title":"Positional MRI changes in supine versus sitting postures in patients with degenerative lumbar spine","volume":"19","author":"Karadimas","year":"2006","journal-title":"J Spinal Disord Tech"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0365","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1136\/aim.22.4.178","article-title":"Biomechanics of back pain","volume":"22","author":"Adams","year":"2004","journal-title":"Acupunct Med"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0370","doi-asserted-by":"crossref","first-page":"468","DOI":"10.2106\/00004623-197052030-00006","article-title":"The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration","volume":"52","author":"Farfan","year":"1970","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"10.1016\/j.mehy.2020.109900_b0375","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1097\/00007632-199211000-00014","article-title":"The mechanical properties of the human l4\u20135 functional spinal unit during cyclic loading: the structural effects of the posterior elements","volume":"17","author":"Asano","year":"1992","journal-title":"Spine"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0380","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/00007632-198005000-00007","article-title":"The resistance to flexion of the lumbar intervertebral joint","volume":"5","author":"Adams","year":"1980","journal-title":"Spine"},{"issue":"9","key":"10.1016\/j.mehy.2020.109900_b0385","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1097\/00007632-198809000-00009","article-title":"The lumbar spine in backward bending","volume":"13","author":"Adams","year":"1988","journal-title":"Spine"},{"issue":"23","key":"10.1016\/j.mehy.2020.109900_b0390","doi-asserted-by":"crossref","first-page":"2683","DOI":"10.1097\/00007632-199412000-00016","article-title":"Spondylolysis: bending of the inferior articular processes of lumbar vertebrae during simulated spinal movements","volume":"19","author":"Green","year":"1994","journal-title":"Spine"},{"issue":"23","key":"10.1016\/j.mehy.2020.109900_b0395","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1097\/00007632-199412010-00012","article-title":"The role of the lumbar facet joints in spinal stability: identification of alternative paths of loading","volume":"19","author":"Haher","year":"1994","journal-title":"Spine"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0400","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00586-002-0488-5","article-title":"Outcome of the Graf ligamentoplasty procedure compared with anterior lumbar interbody fusion with the Hartshill horseshoe cage","volume":"12","author":"Madan","year":"2003","journal-title":"Eur Spine J"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0405","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s005860100254","article-title":"Graf ligament stabilisation: mid- to long-term follow-up","volume":"10","author":"Rigby","year":"2001","journal-title":"Eur Spine J"},{"issue":"11","key":"10.1016\/j.mehy.2020.109900_b0410","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1007\/s00586-014-3533-2","article-title":"Biomechanical evaluation of the Facet Wedge: a refined technique for facet fixation","volume":"23","author":"Hartensuer","year":"2014","journal-title":"Eur Spine J"},{"issue":"4","key":"10.1016\/j.mehy.2020.109900_b0415","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1055\/s-0037-1607196","article-title":"Preliminary experience with a novel system of facet fixation to treat patients with lumbar degenerative disease. a new perspective in minimally invasive spine surgery?","volume":"79","author":"Francaviglia","year":"2018","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"issue":"5","key":"10.1016\/j.mehy.2020.109900_b0420","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1055\/s-0038-1655760","article-title":"Transfacet screw fixation for the treatment of lumbar spinal stenosis with mild instability: a preliminary study","volume":"79","author":"Trungu","year":"2018","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"10.1016\/j.mehy.2020.109900_b0425","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00003086-198410000-00009","article-title":"A mechanistic classification of thoracolumbar spine fractures","volume":"189","author":"Ferguson","year":"1984","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"10.1016\/j.mehy.2020.109900_b0430","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1007\/s00259-017-3765-6","article-title":"Bone SPECT\/CT in the postoperative spine: a focus on spinal fusion","volume":"44","author":"Al-Riyami","year":"2017","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"1","key":"10.1016\/j.mehy.2020.109900_b0435","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s00256-017-2798-z","article-title":"Anterior cervical discectomy and fusion: review and update for radiologists","volume":"47","author":"Kani","year":"2018","journal-title":"Skeletal Radiol"},{"issue":"3","key":"10.1016\/j.mehy.2020.109900_b0440","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.spinee.2013.07.459","article-title":"Methods of evaluating lumbar and cervical fusion","volume":"14","author":"Gruskay","year":"2014","journal-title":"Spine J"},{"issue":"11","key":"10.1016\/j.mehy.2020.109900_b0445","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/BRS.0b013e318171927c","article-title":"Anterior cervical fusion assessment: surgical exploration versus radiographic evaluation","volume":"33","author":"Buchowski","year":"2008","journal-title":"Spine"}],"container-title":["Medical Hypotheses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0306987720306046?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0306987720306046?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T19:24:24Z","timestamp":1759692264000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0306987720306046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":89,"alternative-id":["S0306987720306046"],"URL":"https:\/\/doi.org\/10.1016\/j.mehy.2020.109900","relation":{},"ISSN":["0306-9877"],"issn-type":[{"value":"0306-9877","type":"print"}],"subject":[],"published":{"date-parts":[[2020,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery?","name":"articletitle","label":"Article Title"},{"value":"Medical Hypotheses","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.mehy.2020.109900","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Elsevier Ltd. All rights reserved.","name":"copyright","label":"Copyright"}],"article-number":"109900"}}