Biomechanical Evaluation of Stand-Alone Oblique Lateral Lumbar Interbody Fusion Under 3 Different Bone Mineral Density Conditions: A Finite Element Analysis

Wang, Zemin; Ma, Rong; Cai, Zecheng; Wang, Zhiqiang; Yang, Shulong; Ge, Zhaohui

doi:10.1016/j.wneu.2021.08.049

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…Severe osteoporosis leads to stress fractures, screw loosening, and internal fixation failure after spinal surgery [ 26 ]. A biomechanical finite element analysis showed that with the increase in the degree of osteoporosis, the maximum stress on the upper and lower endplates of the fusion segment increased significantly, thus increasing the potential risk of implant subsidence [ 27 ]. In our study, the HU values of the upper and lower vertebral body and endplate in the subsidence group were significantly lower than those in the non-subsidence group, and those results indicate that BMD is a very important factor in TMC subsidence after ACCF.…”

Section: Discussionmentioning

confidence: 99%

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

et al. 2022

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Study design This study was a retrospective review. Objective To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration.

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Section: Discussionmentioning

confidence: 99%

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

et al. 2022

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“…For simulating osteoporosis, the elastic modulus of cancellous bone is set to reduce by 66%, and the elastic modulus of cortical bone, endplate, and posterior elements is set to reduce by 33%, while the elastic modulus of other structures remains unchanged. With this configuration, finite element analysis discovered that as the degree of osteoporosis increased, the maximum stress on the upper and lower en-plates of the fusion segment increased significantly, increasing the potential risk of implant subsidence in OLIF ( Wang et al, 2021b ). Furthermore, the surgeon must consider the limitations of the stand-alone (SA) and lateral plate-screw (LPS) fixations in OLIF, which may not provide adequate stability for osteoporotic patients ( Bereczki et al, 2021 ; Wang et al, 2021b ).…”

Section: Fea Advances In Icsmentioning

confidence: 99%

“…With this configuration, finite element analysis discovered that as the degree of osteoporosis increased, the maximum stress on the upper and lower en-plates of the fusion segment increased significantly, increasing the potential risk of implant subsidence in OLIF ( Wang et al, 2021b ). Furthermore, the surgeon must consider the limitations of the stand-alone (SA) and lateral plate-screw (LPS) fixations in OLIF, which may not provide adequate stability for osteoporotic patients ( Bereczki et al, 2021 ; Wang et al, 2021b ). Under whole-body vibration (WBV), the osteoporosis of the fused vertebrae may make the adjacent segments more unstable, increasing the risk of adjacent segment disease, subsidence, cage failure, rod failure, and lumbar instability ( Wang and Guo, 2020 ).…”

Section: Fea Advances In Icsmentioning

confidence: 99%

Recent advancement in finite element analysis of spinal interbody cages: A review

Wang

2023

Front. Bioeng. Biotechnol.

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Finite element analysis (FEA) is a widely used tool in a variety of industries and research endeavors. With its application to spine biomechanics, FEA has contributed to a better understanding of the spine, its components, and its behavior in physiological and pathological conditions, as well as assisting in the design and application of spinal instrumentation, particularly spinal interbody cages (ICs). IC is a highly effective instrumentation for achieving spinal fusion that has been used to treat a variety of spinal disorders, including degenerative disc disease, trauma, tumor reconstruction, and scoliosis. The application of FEA lets new designs be thoroughly “tested” before a cage is even manufactured, allowing bio-mechanical responses and spinal fusion processes that cannot easily be experimented upon in vivo to be examined and “diagnosis” to be performed, which is an important addition to clinical and in vitro experimental studies. This paper reviews the recent progress of FEA in spinal ICs over the last six years. It demonstrates how modeling can aid in evaluating the biomechanical response of cage materials, cage design, and fixation devices, understanding bone formation mechanisms, comparing the benefits of various fusion techniques, and investigating the impact of pathological structures. It also summarizes the various limitations brought about by modeling simplification and looks forward to the significant advancement of spine FEA research as computing efficiency and software capabilities increase. In conclusion, in such a fast-paced field, the FEA is critical for spinal IC studies. It helps in quantitatively and visually demonstrating the cage characteristics after implanting, lowering surgeons’ learning costs for new cage products, and probably assisting them in determining the best IC for patients.

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“…In addition, the prevalence of osteoporosis has increased dramatically among the elderly in recent years, and an increasing number of patients requiring lumbar interbody fusion suffer from osteoporosis [ 16 ]. Previous studies reported that osteoporosis significantly altered the normal biomechanics of the lumbar spine [ 17 ] and showed a higher risk of fracture, internal fixation failure, and scaffold subsidence [ 18 , 19 ]. However, according to the existing literature, the biomechanics of lateral scaffolds with various materials were not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Effect of Interbody Implants on the Biomechanical Behavior of Lateral Lumbar Interbody Fusion: A Finite Element Study

Shen¹,

Zhu

Huang³

et al. 2023

JFB

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Porous titanium interbody scaffolds are growing in popularity due to their appealing advantages for bone ingrowth. This study aimed to investigate the biomechanical effects of scaffold materials in both normal and osteoporotic lumbar spines using a finite element (FE) model. Four scaffold materials were compared: Ti6Al4V (Ti), PEEK, porous titanium of 65% porosity (P65), and porous titanium of 80% porosity (P80). In addition, the range of motion (ROM), endplate stress, scaffold stress, and pedicle screw stress were calculated and compared. The results showed that the ROM decreased by more than 96% after surgery, and the solid Ti scaffold provided the lowest ROM (1.2–3.4% of the intact case) at the surgical segment among all models. Compared to solid Ti, PEEK decreased the scaffold stress by 53–66 and the endplate stress by 0–33%, while porous Ti decreased the scaffold stress by 20–32% and the endplate stress by 0–32%. Further, compared with P65, P80 slightly increased the ROM (<0.03°) and pedicle screw stress (<4%) and decreased the endplate stress by 0–13% and scaffold stress by approximately 18%. Moreover, the osteoporotic lumbar spine provided higher ROMs, endplate stresses, scaffold stresses, and pedicle screw stresses in all motion modes. The porous Ti scaffolds may offer an alternative for lateral lumbar interbody fusion.

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Biomechanical Evaluation of Stand-Alone Oblique Lateral Lumbar Interbody Fusion Under 3 Different Bone Mineral Density Conditions: A Finite Element Analysis

Cited by 13 publications

References 22 publications

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

Recent advancement in finite element analysis of spinal interbody cages: A review

Effect of Interbody Implants on the Biomechanical Behavior of Lateral Lumbar Interbody Fusion: A Finite Element Study

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