Comparison of Clinical and Radiographic Results Between Posterior Pedicle-Based Dynamic Stabilization and Posterior Lumbar Intervertebral Fusion for Lumbar Degenerative Disease: A 2-Year Retrospective Study

Wang, Haiying; Lv, Bing

doi:10.1016/j.wneu.2018.02.192

Cited by 15 publications

(18 citation statements)

References 31 publications

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“…It was measured by Grant et al that the stiffness of different areas on the endplate exhibited a trend of decreasing from the outside to the center of the endplate [51]. Microfractures occur when the local stress is higher than the limit of the relevant area [51][52][53][54], leading to osteolysis and cage subsidence [51][52][53][54]. Our studies found that the average stress of the ZK60 group and the Ti group were higher by 54.25 and 96.13% compared to that of the optimized group, whose endplate interface stress was only 0.97 MPa on average.…”

Section: Discussionmentioning

confidence: 99%

A lattice topology optimization of cervical interbody fusion cage and finite element comparison with ZK60 and Ti-6Al-4V cages

Sun

Wang

Cai

et al. 2021

BMC Musculoskelet Disord

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Background In current clinical practice, the most commonly used fusion cage materials are titanium (Ti) alloys. However, titanium alloys are non-degradable and may cause stress shielding. ZK60 is a bio-absorbable implant that can effectively avoid long-term complications, such as stress shielding effects, implant displacement, and foreign body reactions. In this study, we aimed at investigating the biomechanical behavior of the cervical spine after implanting different interbody fusion cages. Methods The finite element (FE) models of anterior cervical disc removal and bone graft fusion (ACDF) with a ZK60 cage and a Ti cage were constructed, respectively. Simulations were performed to evaluate their properties of flexion, extension, lateral bending, and axial rotation of the cervical spine. Moreover, a side-by-side comparison was conducted on the range of motion (ROM), the deformation of cages, the stress in the cages, bone grafts, and cage-end plate interface. Simultaneously, according to the biomechanical analysis results, the microporous structure of the ZK60 cage was improved by the lattice topology optimization technology and validation using static structure. Results The ROMs in the current study were comparable with the results reported in the literature. There was no significant difference in the deformation of the two cages under various conditions. Moreover, the maximum stress occurred at the rear of the cage in all cases. The cage’s and endplate-cage interface’s stress of the ZK60 group was reduced compared with the Ti cage, while the bone graft stress in the ZK60 fusion cage was significantly greater than that in the Ti fusion cage (average 27.70%). We further optimized the cage by filling it with lattice structures, the volume was decreased by 40%, and validation showed more significant biomechanical properties than ZK60 and Ti cages. Conclusion The application of the ZK60 cage can significantly increase the stress stimulation to the bone graft by reducing the stress shielding effect between the two instrumented bodies. We also observed that the stress of the endplate-cage interface decreased as the reduction of the cage’s stiffness, indicating that subsidence is less likely to occur in the cage with lower stiffness. Moreover, we successfully designed a porous cage based on the biomechanical load by lattice optimization.

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Section: Discussionmentioning

confidence: 99%

A lattice topology optimization of cervical interbody fusion cage and finite element comparison with ZK60 and Ti-6Al-4V cages

Sun

Wang

Cai

et al. 2021

BMC Musculoskelet Disord

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“…Note: P values are based on the chi-square test, P < 0.05 mean statistically significant differences dynamic K-Rod stabilization prevents the incorrect motion of unstable segments and reduces intervertebral disc loads and facet joints, thus promoting recovery [16,19].…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

Chen

Yang

et al. 2020

BMC Musculoskelet Disord

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Background This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

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“…It was measured by Grant et al that the stiffness of different areas on the endplate exhibited a trend of decreasing from the outside to the center of the endplate [47]. Microfractures occur when the local stress is higher than the limit of the relevant area [47][48][49][50], leading to osteolysis and cage subsidence [47][48][49][50]. Our studies found that the average stress of the ZK60 group and the Ti group were higher by 54.25% and 96.13% compared to that of the optimized group, whose endplate interface stress was only 0.97 MPa on average.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of cervical interbody fusion cages with ZK60 and Ti-6Al-4V materials: A finite element analysis and lattice topology optimization

Sun¹,

Wang²,

Cai³

et al. 2020

Preprint

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Background In current clinical practice, the most commonly used fusion cage materials are titanium (Ti) alloys. However, titanium alloys are non-degradable and may cause stress shielding. ZK60 is a bio-absorbable implant that can effectively avoid long-term complications, such as stress shielding effects, implant displacement, and foreign body reactions. In this study, we aimed at investigating the biomechanical behavior of the cervical spine after implanting different interbody fusion cages.Methods The finite element (FE) models of anterior cervical disc removal and bone graft fusion (ACDF) with a ZK60 cage and a Ti cage were constructed, respectively. Simulations were performed to evaluate their properties of flexion, extension, lateral bending, and axial rotation of the cervical spine. Moreover, a side-by-side comparison was conducted on the range of motion (ROM), the deformation of cages, the stress in the cages, bone grafts, and cage-end plate interface. Simultaneously, according to the results of biomechanical analysis, the microporous structure of the ZK60 cage was improved by the lattice topology optimization technology and validation using static structure.Results The ROMs in the current study were comparable with the results reported in the literature. There was no significant difference in the deformation of the two cages under various conditions. Moreover, the maximum stress occurred at the rear of the cage in all cases. The cage's and endplate-cage interface's stress of the ZK60 group was reduced compared with the Ti cage, while the bone graft stress in the ZK60 fusion cage was significantly greater than that in the Ti fusion cage (average 27.70%). We further optimized the cage by filling with lattice structures, the volume was decreased by 40%, and validation showed more significant biomechanical properties than ZK60 and Ti cages.Conclusion The application of the ZK60 cage can significantly increase the stress stimulation to the bone graft by reducing the stress shielding effect between the two instrumented bodies. We also observed that the stress of the endplate-cage interface decreased as the reduction of the cage's stiffness, indicating that subsidence is less likely to occur in the cage with lower stiffness. Moreover, we successfully designed a porous cage on the basis of the biomechanical load by lattice optimization.

show abstract

Comparison of Clinical and Radiographic Results Between Posterior Pedicle-Based Dynamic Stabilization and Posterior Lumbar Intervertebral Fusion for Lumbar Degenerative Disease: A 2-Year Retrospective Study

Cited by 15 publications

References 31 publications

A lattice topology optimization of cervical interbody fusion cage and finite element comparison with ZK60 and Ti-6Al-4V cages

A lattice topology optimization of cervical interbody fusion cage and finite element comparison with ZK60 and Ti-6Al-4V cages

Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

Biomechanical comparison of cervical interbody fusion cages with ZK60 and Ti-6Al-4V materials: A finite element analysis and lattice topology optimization

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