Biomechanical Comparison of Transforaminal Lumbar Interbody Fusion With 1 or 2 Cages by Finite-Element Analysis

Xu, Hao; Wen, Jin; Xu, Neng; Zhang, Xiaojian; Zhu, Xiaodong; Zhu, Lixin; Qian, Xuefeng; Wen, Fengbiao; Wu, Weidong; Jiang, Fugui

doi:10.1227/01.neu.0000430320.39870.f7

Cited by 40 publications

(50 citation statements)

References 21 publications

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“…Compared with previous PLIF FE models [16, 17, 24], the current PLIF FE model focused on the important role of posterior complex. Biomechanically, posterior complex acts as the posterior tension band in flexion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, PLIF has been reported to be more rigid than posterolateral fusion [28, 29], and hence patients who undergo are likely to experience a higher incidence of ASD than those who underwent posterolateral fusion [30]. However, most previous PLIF FE analyses have neglected the importance of posterior complex and focused on the altered biomechanical behavior in the fused lumbar spine with spinal fixators and cages [16, 17, 24, 28, 29]. Therefore, our FE model found that the preserved posterior complex led to less ROM, IDP and ligament forces on the proximal adjacent segment in flexion.…”

Section: Discussionmentioning

confidence: 99%

“…The L1 vertebral body was subjected to a 400-N compressive follower preload [16, 17] while the inferior surface of the S1 vertebra was completely fixed in all degrees of freedom. Moreover, additional 7.5-N.m bending moments were applied to simulate flexion, extension, lateral bending and torsion [18, 19].…”

Section: Methodsmentioning

confidence: 99%

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Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Huang

Cheng³

et al. 2016

PLoS ONE

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ObjectiveTo investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries.MethodsA finite element model of the L1–S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared.ResultsIn Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs.ConclusionsPreserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Huang

Cheng³

et al. 2016

PLoS ONE

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“…Then, ABAQUS software (version 2016, Simulia Inc., USA) was used to set the properties of the lumbar spine components. The material properties were described in the previous literature as specified in Table 1 [16][17][18].…”

Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?

Liang

Cui

Zhang

et al. 2020

BMC Musculoskelet Disord

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Background: Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Pedicle screwrod revision possesses sufficient strength and rigidity. However, is a surgical segment with rigid fixation necessary for ASD reoperation? This study aimed to investigate the biomechanical effect of different instrumentation on lateral lumbar interbody fusion (LLIF) for ASD treatment. Methods: A validated L2~5 finite element (FE) model was modified for simulation. ASD was considered the level cranial to the upper-instrumented segment (L3/4). Bone graft fusion in LLIF with bilateral pedicle screw (BPS) fixation occurred at L4/5. The ASD segment for each group underwent a) LLIF + posterior extension of BPS, b) PLIF + posterior extension of BPS, c) LLIF + lateral screw, and d) stand-alone LLIF. The L3/4 range of motion (ROM), interbody cage stress and strain, screw-bone interface stress, cage-endplate interface stress, and L2/3 nucleus pulposus of intradiscal pressure (NP-IDP) analysis were calculated for comparisons among the four models. Results: All reconstructive models displayed decreased motion at L3/4. Under each loading condition, the difference was not significant between models a and b, which provided the maximum ROM reduction (73.8 to 97.7% and 68.3 to 98.4%, respectively). Model c also provided a significant ROM reduction (64.9 to 77.5%). Model d provided a minimal restriction of the ROM (18.3 to 90.1%), which exceeded that of model a by 13.1 times for flexion-extension, 10.3 times for lateral bending and 4.8 times for rotation. Model b generated greater cage stress than other models, particularly for flexion. The maximum displacement of the cage and the peak stress of the cageendplate interface were found to be the highest in model d under all loading conditions. For the screw-bone interface, the stress was much greater with lateral instrumentation than with posterior instrumentation.

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“…In our institution, the PLIF group used a paired cage and the TLIF group used a single cage. We used a single cage as successful fusion can be achieved with a single cage alone in TLIF [16]. In this study, l4 of 40 cages were located in the contralateral position, nine cages in the middle position, and 17 in the ipsilateral position in the TLIF group.…”

Section: Discussionmentioning

confidence: 99%

A morphometric analysis of contralateral neural foramen in TLIF

Cho

Park

et al. 2015

Eur Spine J

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Biomechanical Comparison of Transforaminal Lumbar Interbody Fusion With 1 or 2 Cages by Finite-Element Analysis

Cited by 40 publications

References 21 publications

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?

A morphometric analysis of contralateral neural foramen in TLIF

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