Computational comparison of three different cage porosities in posterior lumbar interbody fusion with porous cage

Chen, Yen-Nien; Chang, Chih-Hung

doi:10.1016/j.compbiomed.2021.105036

Cited by 10 publications

(4 citation statements)

References 36 publications

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“…According to the simulation results, the behavior of spinal tissue and implants was most stable at porosities of 40%–60%. A recent study used finite element simulations to compare the biomechanical effects of three different porosities (12.5%, 41.2%, and 80.8%) with and without bone fusion ( Chen and Chang, 2021 ). According to the findings, the porosity of the porous cage is important for contact pressure on the bone surface and cage stress.…”

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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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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“…The implantation of interbody cages can not only restore the height of the interbody in time but also provide a stable bone grafting bed, guaranteeing shortand long-term stability. [1][2][3] However, new potential complications, including displacement of the cage and collapse of the intervertebral space, have drawn attention to the implanted cage. Open surgery is required in the case of nerve compression and stability decrease after displacement of the cage.…”

Section: Introductionmentioning

confidence: 99%

“…Posterior lumbar interbody fusion (PLIF) and TLIF are safe and effective methods for the treatment of lumbar degenerative disease. The implantation of interbody cages can not only restore the height of the interbody in time but also provide a stable bone grafting bed, guaranteeing short‐ and long‐term stability 1–3 . However, new potential complications, including displacement of the cage and collapse of the intervertebral space, have drawn attention to the implanted cage.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Revision for Long‐Term Symptomatic Cage Retropulsion after TLIF: The Clinical Presentation in a Single Center

Zhu

Jiang

et al. 2023

Orthopaedic Surgery

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Background Cage retropulsion after transforaminal lumbar interbody fusion (TLIF) is a common complication that is more frequently detected in the early postoperative period. Revision in the early stages is relatively less difficult in symptomatic cases. However, cage retropulsion is quite rare for patients with intervertebral osseous fusion in the long term after TLIF, and there are no relevant reports related to the revision plan. Case presentation Here, we report a case of a patient who underwent L4‐S1 TLIF at another hospital 4 years ago, accompanied by recurrent pain and discomfort of the left lower limb after the operation. Due to recent condition aggravation, it was considered to be caused by compression of the nerve root due to cage retropulsion. Nerve root sealing and endoscopy surgery were performed on the operative segment. It was found that cage retropulsion at the L4/5 level was a suspicious focus according to careful analysis of the clinical manifestations of the patient. Selective block of the nerve root on the level resulted in relief of the patient's original symptoms. After the posterior edge of the cage was exposed under the endoscope through an intervertebral foramen approach, the posterior edge of the cage protruding into the spinal canal was removed by high‐speed burr grinding, working casing reduction and other methods. Postoperative symptoms of pain in the low back and lower limb were relieved completely. Conclusions It is feasible to use the power system to remove the retrograde cage under the endoscope through the intervertebral foramen approach for the revision of symptomatic polyether ether ketone (PEEK) cage retropulsion in the long term after TLIF.

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“…Recently, porous titanium scaffolds manufactured by additive manufacturing (AM) have also been used in lumbar interbody fusion. By adjusting pore topology and porosity, the porous AM scaffold could achieve optimal mechanical properties [ 8 , 9 ]. In addition, the porous scaffold facilitated bone ingrowth, which was beneficial for long-term stability [ 10 ].…”

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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Computational comparison of three different cage porosities in posterior lumbar interbody fusion with porous cage

Cited by 10 publications

References 36 publications

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

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

Endoscopic Revision for Long‐Term Symptomatic Cage Retropulsion after TLIF: The Clinical Presentation in a Single Center

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

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