Biomechanical analysis of segmental lumbar lordosis and risk of cage subsidence with different cage heights and alternative placements in transforaminal lumbar interbody fusion

Rastegar, Sajjad; Arnoux, Pierre‐Jean; Wang, Xiaoyu; Aubin, Carl‐Éric

doi:10.1080/10255842.2020.1737027

Cited by 24 publications

(15 citation statements)

References 37 publications

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“…In the MCBT-TT group, the intervertebral disc stress was more dispersed and lower, with the least stress in rotation (3.48 ± 0.57 Mpa). Rastegar et al ( 31 ) demonstrated that cage subsidence was one of the risk factors for failure of lumbar interbody fusion. With the increase of cage stress, subsidence rate increased gradually ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis

et al. 2022

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BackgroundHybrid fixation techniques including the both modified cortical bone trajectory (MCBT) and traditional trajectory (TT) at the L4 and L5 lumbar segment are firstly proposed by our team. Therefore, the purpose of this study is to evaluate and provide specific biomechanical data of the hybrid fixation techniques including the MCBT and TT.MethodsFour human cadaveric specimens were from the anatomy laboratory of Xinjiang Medical University. Four finite-element (FE) models of the L4–L5 lumbar spine were generated. For each of them, four implanted models with the following fixations were established: TT-TT (TT screw at the cranial and caudal level), MCBT-MCBT (MCBT screw at the cranial and caudal level), hybrid MCBT-TT (MCBT screw at the cranial level and TT screw at the caudal level), and TT-MCBT (TT screw at the cranial level and MCBT screw at the caudal level). A 400-N compressive load with 7.5 N/m moments was applied to simulate flexion, extension, lateral bending, and rotation, respectively. The range of motion (ROM) of the L4–L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation were compared.ResultsCompared to the TT-TT group, the MCBT-TT showed a significant lower ROM of the L4–L5 segment (p ≤ 0.009), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.041). TT-MCBT groups showed a significant lower ROM of the L4–L5 segment (p ≤ 0.012), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.038).ConclusionsThe biomechanical properties of the hybrid MCBT-TT and TT-MCBT techniques at the L4–L5 segment are superior to that of stability MCBT-MCBT and TT-TT techniques, and feasibility needs further cadaveric study to verify.

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Section: Discussionmentioning

confidence: 99%

Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis

et al. 2022

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“…They effectively reduced the lateral stress of the intervertebral disc in lateral bending (TT-TT: 9.288 ± 0.395 MPa, CBT-CBT: 8.303 ± 0.370 MPa, CBT-TT: 6.080 ± 0.443 MPa, TT-CBT: 6.413 ± 0.513 MPa), and the intervertebral disc stress was concentrated in the central part in rotation, while at the same time, stress of the edge was dispersed (Figures 6(a) and 6(b) ). Rastegar et al [ 36 ] reported in a previous biomechanical study that cage subsidence has also been shown to be an important risk factor after lumbar interbody fusion. Lower cage stress might be obtained when decompression and fusion at the responsible stage is performed with the hybrid technique.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Kahaer

Zhou

Maitirouzi

et al. 2022

Journal of Healthcare Engineering

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There is no detailed biomechanical research about the hybrid CBT-TT (CBT screws at cranial level and TT screws at caudal level) and TT-CBT (TT screws at cranial level and CBT screws at caudal level) techniques with finite element (FE) method. Therefore, the purpose of this study was to evaluate and provide specific biomechanical data of the hybrid lumbar posterior fixation system and compare with traditional pedicle screw and cortical screw trajectories without fusion, in FE method. Specimens were from the anatomy laboratory of Xinjiang Medical University. Four FE models of the L4-L5 lumbar spine segment were generated. For each of these, four implanted models with the following instruments were created: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT fixation, and hybrid TT-CBT fixation. A 400 N compressive load with 7.5 Nm moments was applied so as to simulate flexion, extension, left lateral bending, right lateral bending, left rotation, and right rotation, respectively. The range of motion (ROM) of the L4-L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation in four implanted models were compared. CBT-TT displayed a lower ROM of the fixation segment (3.82 ± 0.633°) compared to TT-TT (4.78 ± 0.306°) and CBT-CBT (4.23 ± 0.396°). In addition, CBT-TT showed a lower ROM of the posterior fixation (0.595 ± 0.108°) compared to TT-TT (0.795 ± 0.103°) and CBT-CBT (0.758 ± 0.052°). The intervertebral disc stress of CBT-TT (4.435 ± 0.604 MPa) was lower than TT-TT (7.592 ± 0.387 MPa) and CBT-CBT (6.605 ± 0.600 MPa). CBT-TT (20.228 ± 3.044 MPa) and TT-CBT (12.548 ± 2.914 MPa) displayed a lower peak von Mises stress of the posterior fixation compared to TT-TT (25.480 ± 3.737 MPa). The hybrid CBT-TT and TT-CBT techniques offered superior fixation strength compared to the CBT-CBT and TT-TT techniques.

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“…In our experience, the footprint of cages in OLIF is at least twice the size of that in MIS-TLIF and is wide enough to stand on both sides of the dense peripheral apophyseal bone [ 56 – 59 ]. Biomechanical analysis has also suggested that such constructs may effectively diminish stress peaks and disperse the stress in the endplate cancellous bone equally, which is beneficial for both fusion and subsidence resistance [ 60 – 62 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive transforaminal lumbar interbody fusion versus oblique lateral interbody fusion for lumbar degenerative disease: a meta-analysis

Zhang

Tan

Huang

et al. 2021

BMC Musculoskelet Disord

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Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures. Methods A systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF. Results Seven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001). Conclusions The above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF. Trial registration PROSPERO ID: CRD42020201903.

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Biomechanical analysis of segmental lumbar lordosis and risk of cage subsidence with different cage heights and alternative placements in transforaminal lumbar interbody fusion

Abstract: Biomechanical analysis of segmental lumbar lordosis and risk of cage subsidence with different cage heights and alternative placements in transforaminal lumbar interbody fusion

Cited by 24 publications

References 37 publications

Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis

Biomechanical investigation of the hybrid modified cortical bone screw–pedicle screw fixation technique: Finite-element analysis

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study

Minimally invasive transforaminal lumbar interbody fusion versus oblique lateral interbody fusion for lumbar degenerative disease: a meta-analysis

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