Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Zhang, Mingzheng; Pu, Fangling; Xu, Liqiang; Zhang, Linlin; Yao, Jie; Li, Deyu; Wang, Yu; Fan, Yubo

doi:10.1007/s00264-016-3173-8

Cited by 22 publications

(18 citation statements)

References 25 publications

(36 reference statements)

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“…[11][12][13] Surgical approach and placement of interbody cages is another point of consideration, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, and posterolateral lumbar interbody fusion, among others. [14][15][16] Scoliosis and brace design, vibration, and posterior instrumentation associated with spinal fusion surgery have all been studied in great detail. [17][18][19][20] In the majority of cases, FEA research of the lumbar spine is performed using CT scan-based models.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Computationally Efficient Finite Element Model of the Human Lumbar Spine: Application to Disc Degeneration

2020

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Introduction: This study develops and validates an accurate, computationally efficient, 3-dimensional finite element model (FEM) of the human lumbar spine. Advantages of this simplified model are shown by its application to a disc degeneration study that we demonstrate is completed in one-sixth the time required when using more complicated computed tomography (CT) scan-based models. Methods: An osseoligamentous FEM of the L1-L5 spine is developed using simple shapes based on average anatomical dimensions of key features of the spine rather than CT scan images. Pure moments of 7.5 Nm and a compressive follower load of 1000 N are individually applied to the L1 vertebra. Validation is achieved by comparing rotations and intradiscal pressures to other widely accepted FEMs and in vitro studies. Then degenerative disc properties are modeled and rotations calculated. Required computation times are compared between the model presented in this paper and other models developed using CT scans. Results: For the validation study, parameter values for a healthy spine were used with the loading conditions described above. Total L1-L5 rotations for flexion, extension, lateral bending, and axial rotation under pure moment loading were calculated as 20.38, 10.78, 19.78, and 10.38, respectively, and under a compressive follower load, maximum intradiscal pressures were calculated as 0.68 MPa. These values compare favorably with the data used for validation. When studying the effects of disc degeneration, the affected segment is shown to experience decreases in rotations during flexion, extension, and lateral bending (24%-56%), while rotations are shown to increase during axial rotation (14%-40%). Adjacent levels realize relatively minor changes in rotation (1%-6%). This parametric study required 17.5 hours of computation time compared to more than 4 days required if utilizing typical published CT scan-based models, illustrating one of the primary advantages of the model presented in this article. Conclusions: The FEM presented in this article produces a biomechanical response comparable to widely accepted, complex, CT scan-based models and in vitro studies while requiring much shorter computation times. This makes the model ideal for conducting parametric studies of spinal pathologies and spinal correction techniques.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of a Computationally Efficient Finite Element Model of the Human Lumbar Spine: Application to Disc Degeneration

2020

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“…Compared with the other three constructs, the von Mises stress on the bone graft was highest in B+P. Previous biomechanical study had demonstrated that the increased stress distribution of intervertebral implants could increase the risk of implant subsidence and dislodgement based on long-term mechanical evaluation ( Zhang M. et al, 2016 ). In present FEA, the increased stress distribution of bone graft may cause postoperative subsidence and displacement of bone graft.…”

Section: Discussionmentioning

confidence: 99%

“…The finite element models were reconstructed with the purpose of evaluating the stress on the implants preoperatively. It has been reported that the increased stress of implant was associated with the postoperative breakage and subsidence risk of implants ( Zhang M. et al, 2016 ; Fan et al, 2019 ). The present study compared the von Mises stress on the rod, pedicle screws, bone graft, and mesh of the different surgical constructs.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative planning for spinal diseases such as thoracic spinal tuberculosis has not yet been evaluated. It had been reported that the maximal stress of internal implant was related to the risk of postoperative complications, such as screw breakage and mesh or cage subsidence ( Zhang M. et al, 2016 ; Fan et al, 2019 ). In the present study, a finite element model of the thoracic vertebrae was designed to evaluate the biomechanical effects of the different methods of anterior column reconstruction and posterior fixations and to determine which type of posterior fixation provides effective spinal stability and less stress on the internal fixation devices.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis

Wang

Hua

et al. 2020

Front. Bioeng. Biotechnol.

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Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability for the treatment of thoracic spinal tuberculosis. However, the process of selecting the appropriate spinal fixation method remains controversial, and preoperative biomechanical evaluation has not yet been investigated. In this study, we aimed to analyze the application of the assisted finite element analysis (FEA) and the three-dimensional (3D) printed model for the patient-specific preoperative planning of thoracic spinal tuberculosis. An adult patient with thoracic spinal tuberculosis was included. A finite element model of the T7−T11 thoracic spine segments was reconstructed to analyze the biomechanical effect of four different operative constructs. The von Mises stress values of the implants in the vertical axial load and flexion and extension conditions under a 400-N vertical axial pre-load and a 10-N⋅m moment were calculated and compared. A 3D printed model was used to describe and elucidate the patient’s condition and simulate the optimal surgical design. According to the biomechanical evaluation, the patient-specific preoperative surgical design was prepared for implementation. The anterior column, which was reconstructed with titanium alloy mesh and a bone graft with posterior fixation using seven pedicle screws (M+P) and performed at the T7–T11 level, decreased the von Mises stress placed on the right rod, T7 pedicle screw, and T11 pedicle. Moreover, the M+P evaded the left T9 screw without load bearing. The 3D printed model and preoperative surgical simulation enhanced the understanding of the patient’s condition and facilitated patient-specific preoperative planning. Good clinical results, including no complication of implants, negligible loss of the Cobb angle, and good bone fusion, were achieved using the M+P surgical design. In conclusion, M+P was recommended as the optimal method for preoperative planning since it enabled the preservation of the normal vertebra and prevented unnecessary internal fixation. Our study indicated that FEA and the assisted 3D printed model are tools that could be extremely useful and effective in the patient-specific preoperative planning for thoracic spinal tuberculosis, which can facilitate preoperative surgical simulation and biomechanical evaluation, as well as improve the understanding of the patient’s condition.

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“…Zhang et al aimed to study how cage placement affects bone remodelling after PLIF surgery. 15 They found that the single cage model demonstrated superior bone development in the bone graft when placed under a constant 400 N axial compressive load. The results showed that in the initial state prior to any bone remodelling, cage stress, cage subsidence and cage dislodgement in the single cage model were all greater than in the coupled cage model.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of functional outcome of discectomy versus discectomy with posterior lumbar interbody fusion for treatment of lumbar disc herniation

et al. 2019

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Background: Lumbar disc herniation is the most common cause of low back pain and significant disability with economic impact too. Management of disc herniation is challenging, often confusing when surgical treatment is considered, because of frequent failures after surgery in many patients to relieve symptoms.Methods: Our study was a prospective study conducted in Department of Orthopaedics, Coimbatore medical college. Thirty six patients operated for intervertebral disc herniation of lumbar spine from March 2015 to February 2017 were included in the study.Results: VAS score was not significant between two groups, at one month, but at 6 months, PLIF group had better VAS score and was statistically significant. ODI scores showed a similar pattern.Conclusions: Discectomy for symptomatic lumbar disc herniation is still the procedure of choice but with any subtle instability, then it should be combined with stabilisation like posterior lumbar interbody fusion.

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Long-term effects of placing one or two cages in instrumented posterior lumbar interbody fusion

Abstract: Based on the long-term results, instrumented PLIF with a single cage could also be encouraged in clinical practice.

Cited by 22 publications

References 25 publications

Development and Validation of a Computationally Efficient Finite Element Model of the Human Lumbar Spine: Application to Disc Degeneration

Development and Validation of a Computationally Efficient Finite Element Model of the Human Lumbar Spine: Application to Disc Degeneration

Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis

Comparative evaluation of functional outcome of discectomy versus discectomy with posterior lumbar interbody fusion for treatment of lumbar disc herniation

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