{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:40:09Z","timestamp":1789969209758,"version":"4.0.1"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Bilateral symptoms have been reported in 8%\u201335% of patients with sacroiliac (SI) joint dysfunction. Stabilization of a single SI joint may significantly alter the stresses on the contralateral SI joint. If the contralateral SI joint stresses are significantly increased, degeneration may occur; alternatively, if the stresses are significantly reduced, bilateral stabilization may be unnecessary for patients with bilateral symptoms. The biomechanical effects of 1) unilateral stabilization on the contralateral SI joint and 2) bilateral stabilization on both SI joints are currently unknown. The objectives of this study were to characterize bilateral SI joint range of motion (ROM) and evaluate and compare the biomechanical effects of unilateral and bilateral implant placement for SI joint fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A lumbopelvic model (L5\u2013pelvis) was used to test the ROM of both SI joints in 8 cadavers. A single-leg stance setup was used to load the lumbar spine and measure the ROM of each SI joint in flexion-extension, lateral bending, and axial rotation. Both joints were tested 1) while intact, 2) after unilateral stabilization, and 3) after bilateral stabilization. Stabilization consisted of lateral transiliac placement of 3 triangular titanium plasma-sprayed (TPS) implants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Intact testing showed that during single-leg stance the contralateral SI joint had less ROM in flexion-extension (27%), lateral bending (32%), and axial rotation (69%) than the loaded joint. Unilateral stabilization resulted in significant reduction of flexion-extension ROM (46%) on the treated side; no significant ROM changes were observed for the nontreated side. Bilateral stabilization resulted in significant reduction of flexion-extension ROM of the primary (45%) and secondary (75%) SI joints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study demonstrated that during single-leg loading the ROMs for the stance (loaded) and swing (unloaded) SI joints are significantly different. Unilateral stabilization for SI joint dysfunction significantly reduces the ROM of the treated side, but does not significantly reduce the ROM of the nontreated contralateral SI joint. Bilateral stabilization is necessary to significantly reduce the ROM for both SI joints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.7.spine17499","type":"journal-article","created":{"date-parts":[[2018,1,5]],"date-time":"2018-01-05T10:02:26Z","timestamp":1515146546000},"page":"326-332","source":"Crossref","is-referenced-by-count":42,"title":["Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation"],"prefix":"10.3171","volume":"28","author":[{"given":"Derek P.","family":"Lindsey","sequence":"first","affiliation":[{"name":"SI-BONE, Inc., San Jose;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Parrish","sequence":"additional","affiliation":[{"name":"The Taylor Collaboration; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukund","family":"Gundanna","sequence":"additional","affiliation":[{"name":"Brazos Spine, College Station, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremi","family":"Leasure","sequence":"additional","affiliation":[{"name":"The Taylor Collaboration; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Yerby","sequence":"additional","affiliation":[{"name":"SI-BONE, Inc., San Jose;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitriy","family":"Kondrashov","sequence":"additional","affiliation":[{"name":"St. Mary\u2019s Spine Center, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.jbiomech.2013.11.008","article-title":"Two-leg alternate loading model\u2014a different approach to biomechanical investigations of fixation methods of the injured pelvic ring with focus on the pubic symphysis","volume":"47","author":"Agarwal Y","year":"2014","unstructured":"Agarwal Y, Doebele S, Windolf M, Shiozawa T, Gueorguiev B, Stuby FM: Two-leg alternate loading model\u2014a different approach to biomechanical investigations of fixation methods of the injured pelvic ring with focus on the pubic symphysis. J Biomech 47:380\u2013386, 201410.1016\/j.jbiomech.2013.11.00824290178"},{"key":"b2","series-title":"BMC Musculoskelet Disord","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/1471-2474-11-245","article-title":"Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry","volume":"11","author":"Aghayev E","year":"2010","unstructured":"Aghayev E, Beck A, Staub LP, Dietrich D, Melloh M, Orljanski W, : Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry. BMC Musculoskelet Disord 11:245, 201010.1186\/1471-2474-11-24520973941"},{"issue":"217","key":"b3","series-title":"Clin Orthop Relat Res","first-page":"266","article-title":"Recognizing specific characteristics of nonspecific low back pain","author":"Bernard TN Jr","year":"1987","unstructured":"Bernard TN Jr, Kirkaldy-Willis WH: Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res (217):266\u2013280, 19872951048"},{"key":"b4","series-title":"Med Devices (Auckl)","first-page":"73","article-title":"Sacroiliac joint pain: burden of disease","volume":"7","author":"Cher D","year":"2014","unstructured":"Cher D, Polly D, Berven S: Sacroiliac joint pain: burden of disease. Med Devices (Auckl) 7:73\u201381, 201424748825"},{"key":"b5","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1097\/00005131-199611000-00001","article-title":"Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures","volume":"10","author":"Comstock CP","year":"1996","unstructured":"Comstock CP, van der Meulen MC, Goodman SB: Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. J Orthop Trauma 10:517\u2013522, 199610.1097\/00005131-199611000-000018915911"},{"key":"b6","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1055\/s-0035-1562912","article-title":"Triangular titanium implants for minimally invasive sacroiliac joint fusion: a prospective study","volume":"6","author":"Duhon BS","year":"2016","unstructured":"Duhon BS, Cher DJ, Wine KD, Kovalsky DA, Lockstadt H: Triangular titanium implants for minimally invasive sacroiliac joint fusion: a prospective study. Global Spine J 6:257\u2013269, 20162709981710.1055\/s-0035-1562912"},{"key":"b7","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"1422","DOI":"10.1016\/j.jbiomech.2010.02.004","article-title":"Pure moment testing for spinal biomechanics applications: Fixed versus sliding ring cable-driven test designs","volume":"43","author":"Eguizabal J","year":"2010","unstructured":"Eguizabal J, Tufaga M, Scheer JK, Ames C, Lotz JC, Buckley JM: Pure moment testing for spinal biomechanics applications: Fixed versus sliding ring cable-driven test designs. J Biomech 43:1422\u20131425, 201010.1016\/j.jbiomech.2010.02.00420181340"},{"key":"b8","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"932","DOI":"10.2106\/JBJS.N.01101","article-title":"The prevalence of sacroiliac joint degeneration in asymptomatic adults","volume":"97","author":"Eno JJ","year":"2015","unstructured":"Eno JJ, Boone CR, Bellino MJ, Bishop JA: The prevalence of sacroiliac joint degeneration in asymptomatic adults. J Bone Joint Surg Am 97:932\u2013936, 20152604185510.2106\/JBJS.N.01101"},{"key":"b9","series-title":"Neurosurg Focus Suppl","article-title":"Stabilization of the sacroiliac joint with the SI-Bone surgical technique","volume":"35","author":"Geisler F","unstructured":"Geisler F: Stabilization of the sacroiliac joint with the SI-Bone surgical technique. Neurosurg Focus Suppl 35:Video 8, 2013"},{"key":"b10","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1097\/BRS.0b013e318170fd35","article-title":"Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up","volume":"33","author":"Ha KY","year":"2008","unstructured":"Ha KY, Lee JS, Kim KW: Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up. Spine (Phila Pa 1976) 33:1192\u20131198, 200810.1097\/BRS.0b013e318170fd3518469692"},{"key":"b11","series-title":"J Orthop Res","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1002\/jor.22119","article-title":"Relationship between limb length discrepancy and load distribution across the sacroiliac joint\u2014a finite element study","volume":"30","author":"Kiapour A","year":"2012","unstructured":"Kiapour A, Abdelgawad AA, Goel VK, Souccar A, Terai T, Ebraheim NA: Relationship between limb length discrepancy and load distribution across the sacroiliac joint\u2014a finite element study. J Orthop Res 30:1577\u20131580, 201210.1002\/jor.2211922488899"},{"key":"b12","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1007\/s11999-014-3499-8","article-title":"Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?","volume":"472","author":"Ledonio CGT","year":"2014","unstructured":"Ledonio CGT, Polly DW Jr, Swiontkowski MF: Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective? Clin Orthop Relat Res 472:1831\u20131838, 20142451956910.1007\/s11999-014-3499-8"},{"key":"b13","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"64","DOI":"10.14444\/2064","article-title":"Sacroiliac joint fusion minimally affects adjacent lumbar segment motion: a finite element study","volume":"9","author":"Lindsey DP","year":"2015","unstructured":"Lindsey DP, Kiapour A, Yerby SA, Goel VK: Sacroiliac joint fusion minimally affects adjacent lumbar segment motion: a finite element study. Int J Spine Surg 9:64, 20152676715610.14444\/2064"},{"key":"b14","series-title":"Med Devices (Auckl)","first-page":"131","article-title":"Evaluation of a minimally invasive procedure for sacroiliac joint fusion\u2014an in vitro biomechanical analysis of initial and cycled properties","volume":"7","author":"Lindsey DP","year":"2014","unstructured":"Lindsey DP, Perez-Orribo L, Rodriquez-Martinez N, Reyes PM, Newcomb A, Cable A, : Evaluation of a minimally invasive procedure for sacroiliac joint fusion\u2014an in vitro biomechanical analysis of initial and cycled properties. Med Devices (Auckl) 7:131\u2013137, 2014"},{"key":"b15","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1097\/00005131-199711000-00008","article-title":"Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance","volume":"11","author":"MacAvoy MC","year":"1997","unstructured":"MacAvoy MC, McClellan RT, Goodman SB, Chien CR, Allen WA, van der Meulen MC: Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance. J Orthop Trauma 11:590\u2013593, 199710.1097\/00005131-199711000-000089415866"},{"key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1097\/00007632-199608150-00012","article-title":"Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain","volume":"21","author":"Maigne JY","year":"1996","unstructured":"Maigne JY, Aivaliklis A, Pfefer F: Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976) 21:1889\u20131892, 1996887572110.1097\/00007632-199608150-00012"},{"key":"b17","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.jbiomech.2006.01.017","article-title":"Accuracy of an optical active-marker system to track the relative motion of rigid bodies","volume":"40","author":"Maletsky LP","year":"2007","unstructured":"Maletsky LP, Sun J, Morton NA: Accuracy of an optical active-marker system to track the relative motion of rigid bodies. J Biomech 40:682\u2013685, 200710.1016\/j.jbiomech.2006.01.01716580000"},{"key":"b18","series-title":"J Orthop Res","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1002\/jor.1100050112","article-title":"Load-displacement behavior of sacroiliac joints","volume":"5","author":"Miller JA","year":"1987","unstructured":"Miller JA, Schultz AB, Andersson GB: Load-displacement behavior of sacroiliac joints. J Orthop Res 5:92\u2013101, 198710.1002\/jor.11000501123819915"},{"key":"b19","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1097\/01.brs.0000137069.88904.03","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature","volume":"29","author":"Park P","year":"2004","unstructured":"Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE: Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29:1938\u20131944, 20041553442010.1097\/01.brs.0000137069.88904.03"},{"key":"b20","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/00005131-199304000-00002","article-title":"Fixation of transforaminal sacrum fractures: a biomechanical study","volume":"7","author":"Pohlemann T","year":"1993","unstructured":"Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H: Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 7:107\u2013117, 199310.1097\/00005131-199304000-000028459294"},{"key":"b21","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"28","DOI":"10.14444\/3028","article-title":"Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction","volume":"10","author":"Polly DW","year":"2016","unstructured":"Polly DW, Swofford J, Whang PG, Frank C, Glaser JC, Limoni RP, : Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Int J Spine Surg 10:28, 201610.14444\/302827652199"},{"key":"b22","series-title":"Med Devices (Auckl)","first-page":"299","article-title":"One-year outcomes after minimally invasive sacroiliac joint fusion with a series of triangular implants: a multicenter, patient-level analysis","volume":"7","author":"Sachs D","year":"2014","unstructured":"Sachs D, Capobianco R, Cher D, Holt T, Gundanna M, Graven T, : One-year outcomes after minimally invasive sacroiliac joint fusion with a series of triangular implants: a multicenter, patient-level analysis. Med Devices (Auckl) 7:299\u2013304, 201425210479"},{"key":"b23","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/00007632-199501000-00007","article-title":"The sacroiliac joint in chronic low back pain","volume":"20","author":"Schwarzer AC","year":"1995","unstructured":"Schwarzer AC, Aprill CN, Bogduk N: The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 20:31\u201337, 1995770927710.1097\/00007632-199501000-00007"},{"key":"b24","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E27","DOI":"10.1097\/BRS.0b013e31818b8882","article-title":"How often is low back pain not coming from the back?","volume":"34","author":"Sembrano JN","year":"2009","unstructured":"Sembrano JN, Polly DW Jr: How often is low back pain not coming from the back? Spine (Phila Pa 1976) 34:E27\u2013E32, 200910.1097\/BRS.0b013e31818b8882"},{"key":"b25","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E525","DOI":"10.1097\/BRS.0000000000000839","article-title":"The effect of implant placement on sacroiliac joint range of motion: posterior versus transarticular","volume":"40","author":"Soriano-Baron H","year":"2015","unstructured":"Soriano-Baron H, Lindsey DP, Rodriguez-Martinez N, Reyes PM, Newcomb A, Yerby SA, : The effect of implant placement on sacroiliac joint range of motion: posterior versus transarticular. Spine (Phila Pa 1976) 40:E525\u2013E530, 201510.1097\/BRS.0000000000000839"},{"key":"b26","series-title":"Clin Biomech (Bristol, Avon)","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/j.clinbiomech.2014.04.010","article-title":"Influence of flexible fixation for open book injury after pelvic trauma\u2014a biomechanical study","volume":"29","author":"Stuby FM","year":"2014","unstructured":"Stuby FM, Doebele S, Agarwal Y, Windolf M, Gueorguiev B, Ochs BG: Influence of flexible fixation for open book injury after pelvic trauma\u2014a biomechanical study. Clin Biomech (Bristol, Avon) 29:657\u2013663, 201410.1016\/j.clinbiomech.2014.04.01024852652"},{"key":"b27","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1007\/s00586-016-4599-9","article-title":"Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management","volume":"26","author":"Sturesson B","year":"2017","unstructured":"Sturesson B, Kools D, Pflugmacher R, Gasbarrini A, Prestamburgo D, Dengler J: Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management. Eur Spine J 26:708\u2013719, 20172717966410.1007\/s00586-016-4599-9"},{"key":"b28","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/00007632-198902000-00004","article-title":"Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis","volume":"14","author":"Sturesson B","year":"1989","unstructured":"Sturesson B, Selvik G, Ud\u00e9n A: Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine (Phila Pa 1976) 14:162\u2013165, 1989292263610.1097\/00007632-198902000-00004"},{"key":"b29","series-title":"J Arthroplasty","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1016\/j.arth.2015.05.039","article-title":"Perioperative outcomes following unilateral versus bilateral total knee arthroplasty","volume":"30","author":"Suleiman LI","year":"2015","unstructured":"Suleiman LI, Edelstein AI, Thompson RM, Alvi HM, Kwasny MJ, Manning DW: Perioperative outcomes following unilateral versus bilateral total knee arthroplasty. J Arthroplasty 30:1927\u20131930, 20152607230010.1016\/j.arth.2015.05.039"},{"key":"b30","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1302\/0301-620X.70B1.3276697","article-title":"Pelvic ring fractures: should they be fixed?","volume":"70","author":"Tile M","year":"1988","unstructured":"Tile M: Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70:1\u201312, 198810.1302\/0301-620X.70B1.32766973276697"},{"key":"b31","series-title":"J Spine","doi-asserted-by":"publisher","first-page":"185","DOI":"10.4172\/2165-7939.1000185","article-title":"Minimally invasive sacroiliac joint arthrodesis: experience in a prospective series with 24 patients","volume":"3","author":"Vanaclocha-Vanaclocha V","year":"2014","unstructured":"Vanaclocha-Vanaclocha V, Verd\u00fa-L\u00f3pez F, S\u00e1nchez-Pardo M, Gozalbes-Esterelles L, Herrera JM, Rivera-Paz M, : Minimally invasive sacroiliac joint arthrodesis: experience in a prospective series with 24 patients. J Spine 3:185, 201410.4172\/2165-7939.1000185"},{"key":"b32","series-title":"Injury","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/0020-1383(95)92180-I","article-title":"Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring","volume":"26","author":"Varga E","year":"1995","unstructured":"Varga E, Hearn T, Powell J, Tile M: Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 26:75\u201380, 1995772147110.1016\/0020-1383(95)92180-I"},{"key":"b33","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"6","DOI":"10.14444\/2006","article-title":"Sacroiliac joint fusion using triangular titanium implants vs. non-surgical management: six-month outcomes from a prospective randomized controlled trial","volume":"9","author":"Whang PG","year":"2015","unstructured":"Whang PG, Cher D, Polly D, Frank C, Lockstadt H, Glaser J, : Sacroiliac joint fusion using triangular titanium implants vs. non-surgical management: six-month outcomes from a prospective randomized controlled trial. Int J Spine Surg 9:6, 20152578524210.14444\/2006"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/28\/3\/article-p326.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/28\/3\/article-p326.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/28\/3\/article-p326.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T19:58:54Z","timestamp":1681588734000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/28\/3\/article-p326.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":33,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2017.7.spine17499","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}