Biomechanical comparison of four types of instrumentation constructs for revision surgery in lumbar adjacent segment disease: A finite element study

Tan, Quanchang; Liu, Zi‐xuan; Zhao, Yan; Huang, Xinyi; Bai, Hao; Xiong, Zhi‐Gang; Du, Chengbin; Lei, Wei; Wu, Zixiang

doi:10.1016/j.compbiomed.2021.104477

Cited by 18 publications

(22 citation statements)

References 48 publications

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“…The DRCm is a modified conventional dual-rod fixation that has been proven to be mechanically adequate for RS and has been applied in clinical practice (Tan et al, 2021a;Tan et al, 2021b).…”

Section: Discussionmentioning

confidence: 99%

“…A previously validated intact T12-L5 FE model was used in the present study ( Tan et al, 2021a ). Detailed modeling procedures are described briefly as follows: the geometrically intact thoracolumbar model was constructed in Mimics 10.0 (Materialise Technologies, Leuven, Belgium) from computed tomography images of a healthy 30-year-old healthy male subject without spinal abnormalities.…”

Section: Methodsmentioning

confidence: 99%

“…The mean interspace between facets was set at 0.1 mm. The detailed material properties used for the components of the intact FE model were referenced in the previous literature ( Table 1 ) ( Tan et al, 2021a ). Seven ligaments connecting the vertebrae were modeled as tension-only, three-dimensional spring elements ( Table 2 ) ( Naserkhaki et al, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

“…Seven ligaments connecting the vertebrae were modeled as tension-only, three-dimensional spring elements ( Table 2 ) ( Naserkhaki et al, 2018 ). The validated procedure was the same as previously reported methods ( Tan et al, 2021a ).…”

Section: Methodsmentioning

confidence: 99%

“…The interface between facet joints was defined as a frictionless surface-to-surface contact. The contact surface of the pedicle screw and rod, pedicle screw and vertebral body, and cage and endplate were all modeled as tie constraints according to the reported literature ( Zhang et al, 2018 ; Tan et al, 2021a ).…”

Section: Methodsmentioning

confidence: 99%

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Effects of Revision Rod Position on Spinal Construct Stability in Lumbar Revision Surgery: A Finite Element Study

Tan

Huang

Bai

et al. 2022

Front. Bioeng. Biotechnol.

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Revision surgery (RS) is a necessary surgical intervention in clinical practice to treat spinal instrumentation–related symptomatic complications. Three constructs with different configurations have been applied in RS. One distinguishing characteristic of these configurations is that the revision rods connecting previous segments and revision segments are placed alongside, outside, or inside the previous rods at the level of facetectomy. Whether the position of the revision rod could generate mechanical disparities in revision constructs is unknown. The objective of this study was to assess the influence of the revision rod position on the construct after RS. A validated spinal finite element (FE) model was developed to simulate RS after previous instrumented fusion using a modified dual-rod construct (DRCm), satellite-rod construct (SRC), and cortical bone trajectory construct (CBTC). Thereafter, maximum von Mises stress (VMS) on the annulus fibrosus and cages and the ligament force of the interspinous ligament, supraspinous ligament, and ligamentum flavum under a pure moment load and a follower load in six directions were applied to assess the influence of the revision rod position on the revision construct. An approximately identical overall reducing tendency of VMS was observed among the three constructs. The changing tendency of the maximum VMS on the cages placed at L4-L5 was nearly equal among the three constructs. However, the changing tendency of the maximum VMS on the cage placed at L2-L3 was notable, especially in the CBTC under right bending and left axial rotation. The overall changing tendency of the ligament force in the DRCm, SRC, and CBTC was also approximately equal, while the ligament force of the CBTC was found to be significantly greater than that of the DRCm and SRC at L1-L2. The results indicated that the stiffness associated with the CBTC might be lower than that associated with the DRCm and SRC in RS. The results of the present study indicated that the DRCm, SRC, and CBTC could provide sufficient stabilization in RS. The CBTC was a less rigid construct. Rather than the revision rod position, the method of constructing spinal instrumentation played a role in influencing the biomechanics of revision.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%