Biomechanical study of oblique lumbar interbody fusion (OLIF) augmented with different types of instrumentation: a finite element analysis

Cai, Xin-Yi; Bian, Han-Ming; Chen, Chao; Yang, Qiang

doi:10.1186/s13018-022-03143-z

Cited by 23 publications

(27 citation statements)

References 56 publications

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“…The BPS model had greater limitations than the UPS model in all motions. These results are consistent with the findings of previous studies 28,29 . The results of this study suggested that, compared with the SA model, all supplemental fixation modalities enhanced the stability of the lumbar spine structure.…”

Section: Discussionsupporting

confidence: 93%

“…These results are consistent with the findings of previous studies. 28,29 The results of this study suggested that, compared with the SA model, all supplemental fixation modalities enhanced the stability of the lumbar spine structure. A literature review by Oxland et al 30 found that the addition of posterior instrumentation to the interbody spacer significantly increased structural stability, regardless of cage insertion trajectory or screw type.…”

Section: Effects Of All Surgical Models On Rom Of Segmentmentioning

confidence: 71%

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Biomechanical Analysis of Double‐Level Oblique Lumbar Fusion with Different Types of Fixation: A Finite Element‐Based Study

Fan

Zhang

Xue

et al. 2023

Orthopaedic Surgery

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Objective One well‐liked less invasive procedure is oblique lumbar interbody fusion (OLIF). The biomechanical characteristics of double‐level oblique lumbar interbody fusion in conjunction with various internal fixations are poorly understood. The purpose of this study was to clarify the biomechanical characteristics of double‐level oblique lumbar interbody fusion for osteoporosis spines using various internal fixation techniques. Methods Based on CT scans of healthy male volunteers, a complete finite element model of osteoporosis in L1–S1 was established. After validation, L3–L5 was selected as the surgical segment to construct four surgical models: (a) two stand‐alone cages (SA); (b) two cages with unilateral pedicle screws (UPS); (c) two cages with bilateral pedicle screws (BPS); and (d) two cages with bilateral cortical bone trajectory screws (CBT). Segmental range of motion (ROM), cage stress, and internal fixation stress were studied in all surgical models and compared with the intact osteoporosis model. Results The SA model had a minimal reduction in all motions. The CBT model had the most noticeable reduction in flexion and extension activities, while the reduction in the BPS model was slightly less than that in the CBT model but larger than that in the UPS model. The BPS model had the greatest limitation in left–right bending and rotation, which was greater than the UPS and CBT models. CBT had the smallest limitation in left–right rotation. The cage stress of the SA model was the highest. The cage stress in the BPS model was the lowest. Compared with the UPS model, the cage stress in the CBT model was larger in terms of flexion and LB and LR but slightly smaller in terms of RB and RR. In the extension, the cage stress in the CBT model is significantly smaller than in the UPS model. The CBT internal fixation was subjected to the highest stress of all motions. The BPS group had the lowest internal fixation stress in all motions. Conclusions Supplemental internal fixation can improve segmental stability and lessen cage stress in double‐level OLIF surgery. In limiting segmental mobility and lowering the stress of cage and internal fixation, BPS outperformed UPS and CBT.

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Section: Discussionsupporting

confidence: 93%

Section: Effects Of All Surgical Models On Rom Of Segmentmentioning

confidence: 71%

Biomechanical Analysis of Double‐Level Oblique Lumbar Fusion with Different Types of Fixation: A Finite Element‐Based Study

Fan

Zhang

Xue

et al. 2023

Orthopaedic Surgery

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“…Therefore, this is consistent with broken nails caused by stress fatigue in some patients after long-term activity. [37][38][39] This experiment verified that the pedicle screw internal fixation system has an obvious effect on the lumbar spine and that role in maintaining stability can reduce the probability of spinal instability. In this experiment, both models produced stress concentration at the root of the screw and the connection of the screw rod, which is consistent with the position of internal fixation failure and fracture commonly observed in the clinic.…”

Section: Discussionsupporting

confidence: 52%

“…Therefore, this is consistent with broken nails caused by stress fatigue in some patients after long-term activity. [37–39]…”

Section: Discussionmentioning

confidence: 99%

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

Zhang

Song

et al. 2022

Medicine

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Background: To explore the biomechanical characteristics of 2 posterior bilateral pedicle screw fixation methods using finite element analysis.Methods: A normal L3-5 finite element model was established. Based on the verification of its effectiveness, 2 different posterior internal fixation methods were simulated: bilateral pedicle screws (model A) were placed in the L3 and L5 vertebral bodies, and bilateral pedicle screws (model B) were placed in the L3, L4, and L5 vertebral bodies. The stability and stress differences of intervertebral discs, endplates, screws, and rods between models were compared.Results: Compared with the normal model, the maximum stress of the range of motion, intervertebral disc, and endplate of the 2 models decreased significantly. Under the 6 working conditions, the 2 internal fixation methods have similar effects on the stress of the endplate and intervertebral disc, but the maximum stress of the screws and rods of model B is smaller than that of model A.Conclusions: Based on these results, it was found that bilateral pedicle screw fixation in 2 vertebrae L3 and L5 can achieve similar stability as bilateral pedicle screw fixation in 3 vertebrae L3, L4, and L5. However, the maximum stress of the screw and rod in model B is less than that in model A, so this internal fixation method can effectively reduce the risk of fracture. The 3-dimensional finite element model established in this study is in line with the biomechanical characteristics of the spine and can be used for further studies on spinal column biomechanics. This information can serve as a reference for clinicians for surgical selection.

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“…Five supplemental fixations established for OLIF surgical model previously [ 25 ], was evaluated on osteoporotic lumbar spines: standalone OLIF; OLIF with lateral plate fixation (OLIF + LPF); OLIF with translaminar facet joint fixation and unilateral pedicle screw fixation (OLIF + TFJF + UPSF); OLIF with unilateral pedicle screw fixation (OLIF + UPSF); and OLIF with bilateral pedicle screw fixation (OLIF + BPSF). We simulated surgery on the L4-L5 segment (Fig.…”

Section: Methodsmentioning

confidence: 99%

Effects of osteoporosis on the biomechanics of various supplemental fixations co-applied with oblique lumbar interbody fusion (OLIF): a finite element analysis

Liu

Gao

Chen

et al. 2022

BMC Musculoskelet Disord

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Background Oblique lumbar interbody fusion (OLIF) is an important surgical modality for the treatment of degenerative lumbar spine disease. Various supplemental fixations can be co-applied with OLIF, increasing OLIF stability and reducing complications. However, it is unclear whether osteoporosis affects the success of supplemental fixations; therefore, this study analyzed the effects of osteoporosis on various supplemental fixations co-applied with OLIF. Methods We developed and validated an L3-S1 finite element (FE) model; we assigned different material properties to each component and established models of the osteoporotic and normal bone lumbar spine. We explored the outcomes of OLIF combined with each of five supplemental fixations: standalone OLIF; OLIF with lateral plate fixation (OLIF + LPF); OLIF with translaminar facet joint fixation and unilateral pedicle screw fixation (OLIF + TFJF + UPSF); OLIF with unilateral pedicle screw fixation (OLIF + UPSF); and OLIF with bilateral pedicle screw fixation (OLIF + BPSF). Under the various working conditions, we calculated the ranges of motion (ROMs) of the normal bone and osteoporosis models, the maximum Mises stresses of the fixation instruments (MMSFIs), and the average Mises stresses on cancellous bone (AMSCBs). Results Compared with the normal bone OLIF model, no demonstrable change in any segmental ROM was apparent. The MMSFIs increased in all five osteoporotic OLIF models. In the OLIF + TFJF + UPSF model, the MMSFIs increased sharply in forward flexion and extension. The stress changes of the OLIF + UPSF, OLIF + BPSF, and OLIF + TFJF + UPSF models were similar; all stresses trended upward. The AMSCBs decreased in all five osteoporotic OLIF models during flexion, extension, lateral bending, and axial rotation. The average stress change of cancellous bone was most obvious under extension. The AMSCBs of the five OLIF models decreased by 14%, 23.44%, 21.97%, 40.56%, and 22.44% respectively. Conclusions For some supplemental fixations, the AMSCBs were all reduced and the MMSFIs were all increased in the osteoporotic model, compared with the OLIF model of normal bone. Therefore, the biomechanical performance of an osteoporotic model may be inferior to the biomechanical performance of a normal model for the same fixation method; in some instances, it may increase the risks of fracture and internal fixation failure.

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Biomechanical study of oblique lumbar interbody fusion (OLIF) augmented with different types of instrumentation: a finite element analysis

Cited by 23 publications

References 56 publications

Biomechanical Analysis of Double‐Level Oblique Lumbar Fusion with Different Types of Fixation: A Finite Element‐Based Study

Biomechanical Analysis of Double‐Level Oblique Lumbar Fusion with Different Types of Fixation: A Finite Element‐Based Study

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

Effects of osteoporosis on the biomechanics of various supplemental fixations co-applied with oblique lumbar interbody fusion (OLIF): a finite element analysis

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