Biomechanical analysis of lumbar interbody fusion supplemented with various posterior stabilization systems

Fan, Wei; Guo, Li Xin; Zhang, Ming

doi:10.1007/s00586-021-06856-7

Cited by 27 publications

(16 citation statements)

References 40 publications

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“…As the main bridge between the upper and lower vertebrae, a suitable intervertebral fusion cage is essential to post-operative recovery [ 34 , 35 ]. High stresses concentrated on the cage surface may lead to subsidence [ 12 , 36 ]. Therefore, effectively reducing the stress on the cage and stress concentrations, for a more uniform stress distribution on the cage to maintain a positive stimulation effect on bone growth, is a research hotspot [ [37] , [38] , [39] ].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

Sun

Han

Sui

et al. 2023

Heliyon

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Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

Sun

Han

Sui

et al. 2023

Heliyon

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“…A mesh convergency test on the intact model was performed by evaluating intradiscal pressure (IDP) change with different mesh sizes. The model was considered converged if the change of computed IDP was less than 3% ( 35 , 36 ), multi-indicators model validation has been accomplished by comparing the computed ROM, IDP, the disc compression (DC), and the facet contact force with values from in-vitro studies under different sizes and directions load to ensure computational credibility ( 37 , 38 ).…”

Section: Methodsmentioning

confidence: 99%

Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study

Huang

Liu²,

Wei³

et al. 2023

Front. Surg.

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BackgroundThe fixation-induced biomechanical deterioration will increase the risk of adjacent segment diseases (ASD) after lumbar interbody fusion with Bilateral pedicle screw (BPS) fixation. The accurate adjustment of insertional pedicle screw positions is possible, and published studies have reported its mechanical effects. However, no studies clarified that adjusting insertional screw positions would affect the postoperative biomechanical environment and the risk of ASD. The objective of this study was to identify this issue and provide theoretical references for the optimization of insertional pedicle screw position selections.MethodsThe oblique lumbar interbody fusion fixed by BPS with different insertional positions has been simulated in the L4-L5 segment of our previously constructed and validated lumbosacral model. Biomechanical indicators related to ASD have been computed and recorded under flexion, extension, bending, and axial rotation loading conditions.ResultsThe change of screw insertional positions has more apparent biomechanical effects on the cranial than the caudal segment. Positive collections can be observed between the reduction of the fixation length and the alleviation of motility compensation and stress concentration on facet cartilages. By contrast, no pronounced tendency of stress distribution on the intervertebral discs can be observed with the change of screw positions.ConclusionsReducing the fixation stiffness by adjusting the insertional screw positions could alleviate the biomechanical deterioration and be an effective method to reduce the risk of ASD caused by BPS.

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“…To eliminate the confounding effect of mesh sizes on computational results, we performed a mesh convergence test on the calibrated intact model by evaluating the change in intradiscal pressure (IDP) with different mesh sizes. The model was considered converged if the change in the computed IDP was less than 3% ( Ottardi et al, 2016 ; Fan et al, 2021 ). The degrees of freedom of S1 inferior surfaces were fixed entirely.…”

Section: Methodsmentioning

confidence: 99%

Deterioration of the fixation segment’s stress distribution and the strength reduction of screw holding position together cause screw loosening in ALSR fixed OLIF patients with poor BMD

Yang

Xie

et al. 2022

Front. Bioeng. Biotechnol.

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The vertebral body’s Hounsfield unit (HU) value can credibly reflect patients’ bone mineral density (BMD). Given that poor bone-screw integration initially triggers screw loosening and regional differences in BMD and strength in the vertebral body exist, HU in screw holding planes should better predict screw loosening. According to the stress shielding effect, the stress distribution changes in the fixation segment with BMD reduction should be related to screw loosening, but this has not been identified. We retrospectively collected the radiographic and demographic data of 56 patients treated by single-level oblique lumbar interbody fusion (OLIF) with anterior lateral single rod (ALSR) screw fixation. BMD was identified by measuring HU values in vertebral bodies and screw holding planes. Regression analyses identified independent risk factors for cranial and caudal screw loosening separately. Meanwhile, OLIF with ALSR fixation was numerically simulated; the elastic modulus of bony structures was adjusted to simulate different grades of BMD reduction. Stress distribution changes were judged by computing stress distribution in screws, bone-screw interfaces, and cancellous bones in the fixation segment. The results showed that HU reduction in vertebral bodies and screw holding planes were independent risk factors for screw loosening. The predictive performance of screw holding plane HU is better than the mean HU of vertebral bodies. Cranial screws suffer a higher risk of screw loosening, but HU was not significantly different between cranial and caudal sides. The poor BMD led to stress concentrations on both the screw and bone-screw interfaces. Biomechanical deterioration was more severe in the cranial screws than in the caudal screws. Additionally, lower stress can also be observed in fixation segments’ cancellous bone. Therefore, a higher proportion of ALSR load transmission triggers stress concentration on the screw and bone-screw interfaces in patients with poor BMD. This, together with decreased bony strength in the screw holding position, contributes to screw loosening in osteoporotic patients biomechanically. The trajectory optimization of ALSR screws based on preoperative HU measurement and regular anti-osteoporosis therapy may effectively reduce the risk of screw loosening.

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Biomechanical analysis of lumbar interbody fusion supplemented with various posterior stabilization systems

Cited by 27 publications

References 40 publications

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

Biomechanical analysis of customized cage conforming to the endplate morphology in anterior cervical discectomy fusion: A finite element analysis

Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study

Deterioration of the fixation segment’s stress distribution and the strength reduction of screw holding position together cause screw loosening in ALSR fixed OLIF patients with poor BMD

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