A novel narrow surface cage for full endoscopic oblique lateral lumbar interbody fusion: A finite element study

Ling, Qinjie; He, Erxing; Lin, Hui; Huang, Wenhua

doi:10.1016/j.jos.2019.08.013

Cited by 13 publications

(11 citation statements)

References 24 publications

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“…Attribute assignment and load settings Using MSC.Patran2012 software (NASA, USA), the cortical bone, cancellous bone, posterior elements, BMEZ, PMMA, PMMA-cancellous bone complex, facet cartilage, annulus bers layers, annulus ground, and nucleus were endowed with properties as shown in Table 1 [16][17][18][19][20]. The anterior longitudinal ligament, posterior longitudinal ligament, ligamentum avum, intertransverse ligament, articular capsule, interspinal ligaments, and supraspinal ligament were all simulated using 1D spring elements, all of which were reconstructed according to the normal anatomical distribution.…”

Section: Surgical Simulation and Model Groupingmentioning

confidence: 99%

“…The anterior longitudinal ligament, posterior longitudinal ligament, ligamentum avum, intertransverse ligament, articular capsule, interspinal ligaments, and supraspinal ligament were all simulated using 1D spring elements, all of which were reconstructed according to the normal anatomical distribution. All ligaments were set as one-way springs that were only under tension and not under pressure, with the corresponding material properties shown in Table 2 [16]. Note: ligament is to generate 1D linear element structure based on the corresponding grid nodes on the mesh model.…”

Section: Attribute Assignment and Load Settingsmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

Cai

Luo

Cao

et al. 2021

Preprint

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Study design: Finite element simulation study.Objective: To compare the biomechanical effects of percutaneous vertebral augmentation (PVA) and percutaneous cement discoplasty (PCD) in patients with symptomatic Schmorl’s node combined with Modic change.Methods: CT data from a single patient was assembled into finite element models, from which we constructed four distinct surgical models, including PVA-ideal, PVA-nonideal, PCD-ideal, and PCD-nonideal, to compare the stress and strain differences of parapodular tissues.Results: The validity of our model was confirmed. PVA-ideal model showed a moderate reduction in the stress peak of the Schmorl’s node (0.48 vs. 0.81–0.89 Mpa) in the erect position. In the PCD-ideal model, the stress peak of the Schmorl’s node increased significantly when the spine was moved toward the lesion (3.99Mpa). Both PVA-ideal and PCD-ideal models showed global strain inhibition at the Schmorl’s node and BMEZ, which was attenuated in the non-ideal models. The PCD-ideal model significantly reduced segmental ROM (-76.8% to -59.3%) and significantly increases endplate stress (up to 220.8%), with no such effects seen in the PVA-ideal model.Conclusions: Both PVA-ideal and PCD-ideal models facilitated a more stable parapodular biomechanical microenvironment. The PVA-ideal model yielded minimal stress disturbance on the augmented or adjacent vertebral endplate but offered no improvement to segment stability. The PCD-ideal model provides adequate segment stability, but also carries a greater risk for adjacent vertebral fracture. As nonideal implementations of both surgeries can result in poor biomechanical outcomes, the surgical indications of PVA or PCD need to be carefully selected.

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Section: Surgical Simulation and Model Groupingmentioning

confidence: 99%

Section: Attribute Assignment and Load Settingsmentioning

confidence: 99%

Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

Cai

Luo

Cao

et al. 2021

Preprint

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“…The majority of lumbar interbody fusion surgeries with integrated endoscopy system are performed through the transforaminal approach [14][15][16][17][18]. Anatomical studies have shown that the size of Kambin's triangle in each segment of the lumbar spine is safe for interbody fusion cages [19][20]. The key is how to fully expose and utilize the Kambin's triangle.…”

Section: Development Challenge and Thinking Of Lumbar Interbody Fusionmentioning

confidence: 99%

Oblique Fixation from Posterior Corner in Lumbar Spine Through Kambin’s Triangle: A Neuroimaging Anatomic Assessment

Chen¹,

Xin²,

Su³

et al. 2020

Preprint

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Background: Traditional lumbar interbody fusion has many limitations, such as large trauma, severe damage to the normal posterior structure, and long postoperative recovery period. With the advance of minimally invasive surgery and spinal endoscopy, new fusion technologies such as percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-LIF) through Kambin’s triangle with less trauma, less bleeding and faster recovery have been developed. However, nerve root injury and dural tears are important complications, and Kambin’s triangle is not "safe". Moreover, fusion after decompression often requires placement of a 14-mm channel, removal of more articular processes, fixation with posterior percutaneous pedicle screw, and changes of intraoperative position or anesthesia, which are inconvenient. One-stop percutaneous endoscopic transforaminal oblique fixation from posterior corner in lumbar spine overcomes the above limitations, and realizes one-stop decompression, fusion and fixation in a single regular minimally invasive channel. The purpose of this study is to measure the neuroimaging anatomic parameters of the nerves related to oblique fixation from posterior corner in lumbar spine through Kambin’s triangle, to define and evaluate the safe working area in Kambin’s triangle, and to identify the optimal target area for endoscopic fusion and fixation.Methods: Sixty volunteers (27 males and 33 females) underwent lumbar MR examination (VISTA,3D-STIR-TSE Sequence) and the data were uploaded to Philips (Achieva 1.5T MR) workstation. Three working targets (P1, P2, P3) were preset for oblique fixation from posterior corner in lumbar spine. The distances from the working targets to exiting nerve roots and dural sac/traversing nerve roots in the coronal and sagittal planes, and the distances from the exiting roots to the dural sac/traversing nerve roots in the upper and lower endplate planes were measured and statistically analyzed.Results: In L1/2–L5/S1, the P values of paired t-test for the distances (c1, c2, c3, c4, c5 and c6) from each target (P1, P2 and P3) to the ipsilateral exiting nerve roots and dural sac/traversing nerve roots were all greater than 0.05. There were no statistically significant differences between the targets at both sides of the same segment, and the mean values of both sides were calculated. The c1, c2, c3, c4, c5 and c6 all increased and then decreased, gradually increased from L1/2, maximized in L4/5, and decreased slightly in L5/S1. As the targets (P1, P2, P3) moved laterally along the horizontal midline of the posterior margin of intervertebral disc, the distance to the dural sac/traversing nerve roots gradually increased, while the distance to the exiting roots gradually decreased. The distance from P1 to exiting nerve roots was significantly greater (1–3 mm) than that to dural sac/traversing nerve roots. The distance from P3 to exiting nerve roots was significantly smaller (1–3 mm) than that to dural sac/traversing nerve roots. The distances from P2 to exiting nerve roots and to dural sac/traversing nerve roots did not different significantly in each segment, and the differences in means were within 1 mm.The distances from exiting nerve roots to dural sac/traversing nerve roots in the upper and lower endplate planes (d1, d2) gradually increased in L1/2–L5/S1 (P<0.0001) and the means of d2 were greater than d1 (P<0.05). There was no statistically significant difference between the left and right sides in the upper and lower endplates in each segment (P=0.26).In L1/2–L5/S1, the P values of paired t-test for the distances (s1, s2, s3, s4, s5, s6) from the projection points of posterior-inferior (posterior-superior) corner of upper (lower) vertebral body to exiting nerve roots in the sagittal planes passing the targets were all greater than 0.05. There was no statistically significant difference between both sides of the same segment, and thus the mean value was calculated. With the outward shift of the targets in the sagittal planes, s1, s3 and s5 gradually decreased (s1>s3>s5), and the same trend was found for s2, s4 and s6 (s2>s4>s6). The distances gradually increased in each segment from the smallest value in L1/2 to the largest value in L5/S1.Conclusion: Kambin’s triangle can be used as a working area for oblique fixation from posterior corner in lumbar spine, but the actual safe area is smaller than theoretical prediction. The intersection point between the vertical line from the medial 1/3 of pedicle and the horizontal midline of the posterior margin of intervertebral disc (P2) is an ideal "target" for oblique fixation from posterior corner in lumbar spine. It is neuroanatomically feasible to achieve one-stop complete decompression, fusion, and fixation in a single channel under spinal endoscopy. Further biomechanical studies and clinical trials are needed to determine whether it can be a new option for posterior spinal fusion.

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“…Instead of the wide surface cage, the narrow surface cage was used by OL-LIF for inserting to the intervertebral space through an endoscopic working tunnel. Biomechanical evaluation showed that a narrow surface cage with 9 mm width was recommended in OL-LIF [ 6 ]. When a small cage was used, the demand of a screw-rods system for function spinal unit (FSU) stability was increased.…”

Section: Introductionmentioning

confidence: 99%

“…Cage and screw fixation combination has been prove to achieve adequate vertebral stability in LIF [ 19 , 20 ]. Recently, a novel narrow surface cage has been introduced to OL-LIF [ 6 ]. The result suggested that a 9 mm width cage was recommended in such minimally spinal surgery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Screws Fixation for Oblique Lateral Lumbar Interbody Fusion (OL-LIF): A Finite Element Study

Ling

2021

BioMed Research International

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Background. The combination of screw fixation and cage can provide stability in lumbar interbody fusion (LIF), which is an important technique to treat lumbar degeneration diseases. As the narrow surface cage is developed in oblique lateral lumbar interbody fusion (OL-LIF), screw fixation should be improved at the same time. We used the finite element (FE) method to investigate the biomechanics response by three different ways of screw fixation in OL-LIF. Methods. Using a validated FE model, OL-LIF with 3 different screw fixations was simulated, including percutaneous transverterbral screw (PTVS) fixation, percutaneous cortical bone trajectory screw (PCBTS) fixation, and percutaneous transpedical screw (PPS) fixation. Range of motion (ROM), vertebral body displacement, cage displacement, cage stress, cortical bone stress, and screw stress were compared. Results. ROM in FE models significantly decreased by 84-89% in flexion, 91-93% in extension, 78-89% in right and left lateral bending, and 73-82% in right and left axial rotation compared to the original model. The maximum displacement of the vertebral body and the cage in six motions except for the extension of model PTVS was the smallest among models. Meanwhile, the model PTVS had the higher stress of screw-rods system and also the lowest stress of cage. In all moments, the maximum stresses of the cages were lower than their yield stress. Conclusions. Three screw fixations can highly restrict the surgical functional spinal unit (FSU). PTVS provided the better stability than the other two screw fixations. It may be a good choice for OL-LIF.

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A novel narrow surface cage for full endoscopic oblique lateral lumbar interbody fusion: A finite element study

Cited by 13 publications

References 24 publications

Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

Biomechanical Comparison of Vertebral Augmentation and Cement Discoplasty for the Treatment of Symptomatic Schmorl’s Node Combined With Modic Change: Finite Element Analyses

Oblique Fixation from Posterior Corner in Lumbar Spine Through Kambin’s Triangle: A Neuroimaging Anatomic Assessment

Screws Fixation for Oblique Lateral Lumbar Interbody Fusion (OL-LIF): A Finite Element Study

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