Does Cage Position Affect the Risk of Cage Subsidence After Oblique Lumbar Interbody Fusion in the Osteoporotic Lumbar Spine: A Finite Element Analysis

Qin, Yichuan; Zhao, Bin; Yuan, Jie; Xu, Chaojian; Su, Junqiang; Hao, Jiaqi; Lv, Jie; Wang, Yongfeng

doi:10.1016/j.wneu.2022.01.107

Cited by 15 publications

(8 citation statements)

References 36 publications

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“…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. [40][41][42] In this study, it was found that the minimum value of the screw stress in each model occurred during extension. Under 6 working conditions, the maximum stress of the screw and rod of model B was less than that of model A, indicating that the screws and rods in this internal fixation method are less likely to be broken.…”

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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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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“…The incidence of CS in stand-alone OLIF group was higher than that in OLIF + BPSF group. There are many reasons for endplate injury and cage subsidence after OLIF, such as obesity, osteoporosis, intraoperative iatrogenic endplate injury, intraoperative cage placement, and too small cage [ 35 , 36 ]. Many scholars have found that OLIF + BPSF is an ideal internal fixation method and has the best biomechanical properties through the study of OLIF combined with different internal fixation systems [ 11 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical differences between two different shapes of oblique lumbar interbody fusion cages on whether to add posterior internal fixation system: a finite element analysis

Liu,

Geng,

Wang

et al. 2023

J Orthop Surg Res

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Background Oblique lateral lumbar fusion (OLIF) is widely used in spinal degeneration, deformity and other diseases. The purpose of this study was to investigate the biomechanical differences between two different shapes of OLIF cages on whether to add posterior internal fixation system, using finite element analysis. Methods A complete three-dimensional finite element model is established and verified for L3–L5. Surgical simulation was performed on the verified model, and the L4–L5 was the surgical segment. A total of the stand-alone group (Model A1, Model B1) and the BPSF group (Model A2, Model B2) were constructed. The four OLIF surgical models were: A1. Stand-alone OLIF with a kidney-shaped Cage; B1. Stand-alone OLIF with a straight cage; A2. OLIF with a kidney-shaped cage + BPSF; B2. Stand-alone OLIF with a straight cage + BPSF, respectively. The differences in the range of motion of the surgical segment (ROM), equivalent stress peak of the cage (ESPC), the maximum equivalent stress of the endplate (MESE) and the maximum stress of the internal fixation (MSIF) were compared between different models. Results All OLIF surgical models showed that ROM declines between 74.87 and 96.77% at L4–L5 operative levels. The decreasing order of ROM was Model A2 > Model B2 > Model A1 > Model A2. In addition, the ESPC and MESE of Model A2 are smaller than those of other OLIF models. Except for the left-bending position, the MSIF of Model B2 increased by 1.51–16.69% compared with Model A2 in each position. The maximum value of MESE was 124.4 Mpa for Model B1 in the backward extension position, and the minimum value was 7.91 Mpa for Model A2 in the right rotation. Stand-alone group showed significantly higher ROMs and ESPCs than the BPSF group, with maximum values of 66.66% and 70.59%. For MESE, the BPSF group model can be reduced by 89.88% compared to the stand-alone group model. Conclusions Compared with the traditional straight OLIF cage, the kidney-shaped OLIF cage can further improve the stability of the surgical segment, reduce ESPC, MESE and MSIF, and help to reduce the risk of cage subsidence.

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“…The lumbar finite element model was developed through the addition of ligaments, mesh separation, and the assignment of respective material properties, setting loading conditions, and performing finite element analysis in Abaqus 2018 (Dassault Systèmes, United States). The material properties for various lumbar structures were obtained from literature sources ( Li et al, 2019a ; Li et al, 2019b ; Li et al, 2020 ; Qin et al, 2022 ) ( Table 1 ; Figure 2H -N). M1 is a complete model with intact ligaments and cartilage.…”

Section: Methodsmentioning

confidence: 99%

“…The inferior surface of the L5 vertebra was constrained, and a follower load of 400N was applied to the superior surface of the L3 vertebra to simulate physiological compression loading. Additionally, a torque of 10Nm was applied to L3 to simulate six types of lumbar activities including flexion, extension, lateral flexion, and rotation ( Fan et al, 2019 ; Wang et al, 2020 ; Qin et al, 2022 ). The lumbar spine mobility and maximum von Mises stress on the L4/L5 intervertebral space were calculated through finite element analysis.…”

Section: Methodsmentioning

confidence: 99%

Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery

Liu,

Zhang,

et al. 2024

Front. Bioeng. Biotechnol.

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Introduction: The application prospects of percutaneous endoscopic lumbar discectomy (PELD) as a minimally invasive spinal surgery method in the treatment of lumbar disc herniation are extensive. This study aims to find the optimal entry angle for the trephine at the L4/5 intervertebral space, which causes less lumbar damage and has greater postoperative stability. To achieve this, we conduct a three-dimensional simulated analysis of the degree of damage caused by targeted puncture-based trephine osteotomy on the lumbar spine.Methods: We gathered clinical CT data from patients to construct a lumbar model. This model was used to simulate and analyze the variations in trephine osteotomy volume resulting from targeted punctures at the L4/5 interspace. Furthermore, according to these variations in osteotomy volume, we created Finite Element Analysis (FEA) models specifically for the trephine osteotomy procedure. We then applied mechanical loads to conduct range of motion and von Mises stress analyses on the lumbar motion unit.Results: In percutaneous endoscopic interlaminar discectomy, the smallest osteotomy volume occurred with a 20° entry angle, close to the base of the spinous process. The volume increased at 30° and reached its largest at 40°. In percutaneous transforaminal endoscopic discectomy, the largest osteotomy volume was observed with a 50° entry angle, passing through the facet joints, with smaller volumes at 60° and the smallest at 70°. In FEA, M6 exhibited the most notable biomechanical decline, particularly during posterior extension and right rotation. M2 and M3 showed significant differences primarily in rotation, whereas the differences between M3 and M4 were most evident in posterior extension and right rotation. M5 displayed their highest stress levels primarily in posterior extension, with significant variations observed in right rotation alongside M4.Conclusion: The appropriate selection of entry sites can reduce lumbar damage and increase stability. We suggest employing targeted punctures at a 30° angle for PEID and at a 60° angle for PTED at the L4/5 intervertebral space. Additionally, reducing the degree of facet joint damage is crucial to enhance postoperative stability in lumbar vertebral motion units.

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Does Cage Position Affect the Risk of Cage Subsidence After Oblique Lumbar Interbody Fusion in the Osteoporotic Lumbar Spine: A Finite Element Analysis

Cited by 15 publications

References 36 publications

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

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

Biomechanical differences between two different shapes of oblique lumbar interbody fusion cages on whether to add posterior internal fixation system: a finite element analysis

Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery

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