Purpose. To evaluate the biomechanics of a novel fusion strategy (hybrid internal fixation+horizontal cage position) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods. MIS-TLIF finite element models for three fusion strategies were created based on computed tomography images, namely, Model-A, hybrid internal fixation (ipsilateral pedicle screw and contralateral translaminar facet screw fixation)+horizontal cage position; Model-B, bilateral pedicle screw (BPS) fixation+horizontal cage position; and Model-C, BPS fixation+oblique 45° cage position. A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models’ range of motion (ROM), peak stress of the internal fixation system, and cage were assessed. Results. The ROM for Models A, B, and C were not different ( P > 0.05 ) but were significantly lower than the ROM of Model-INT ( P < 0.0001 ). Although there were subtle differences in the ROM ratio for Models A, B, and C, the trend was similar. The peak stress of the internal fixation system was significantly higher in Model-A than that of Models B and C, but only the difference between Models A and B was significant ( P < 0.05 ). The peak stress of the cage in Model-A was significantly lower than that of Models B and C ( P < 0.01 ). Conclusion. Hybrid internal fixation with horizontal single cage implantation can provide the same biomechanical stability as traditional fixation while reducing peak stress on the cage and vertebral endplate.
BackgroundThe position and number of cages in minimally invasive transforaminal interbody fusion (MIS-TLIF) are mainly determined by surgeons based on their individual experience. Therefore, it is important to investigate the optimal number and position of cages in MIS-TLIF.MethodsThe lumbar model was created based on a 24-year-old volunteer's computed tomography data and then tested using three different cage implantation methods: single transverse cage implantation (model A), single oblique 45° cage implantation (model B), and double vertical cage implantation (model C). A preload of 500 N and a moment of 10 Nm were applied to the models to simulate lumbar motion, and the models' range of motion (ROM), ROM ratio, peak stress of the internal fixation system, and cage were assessed.ResultsThe ROM ratios of models A, B, and C were significantly reduced by >71% compared with the intact model under all motions. Although there were subtle differences in the ROM ratio for models A, B, and C, the trends were similar. The peak stress of the internal fixation system appeared in model B of 136.05 MPa (right lateral bending), which was 2.07 times that of model A and 1.62 times that of model C under the same condition. Model C had the lowest cage stress, which was superior to that of the single-cage model.ConclusionIn MIS-TLIF, single long-cage transversal implantation is a promising standard implantation method, and double short-cage implantation is recommended for patients with severe osteoporosis.
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