Effect of single and multilevel artificial inter-vertebral disc replacement in lumbar spine: A finite element study

Biswas, Jayanta Kumar; Rana, Masud; Malas, Anindya; Roy, Sandipan; Chatterjee, Subhomoy; Choudhury, Sandeep

doi:10.1177/03913988211001875

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…To avoid these complications associated with lumbar fusion surgery, artificial disc replacement (ADR) was developed for degenerative lumbar spinal diseases which do not require alignment correction. In a study using finite element analysis, single level ADR showed satisfactory results; however, multilevel ADR showed hypermobility which may lead to alter natural movement of spine and implant failure [ 10 ]. In clinical practice, whether ADR is superior to fusion is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis

Son

Lee

et al. 2022

BioMed Research International

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Multilevel lumbar fusion with posterior pedicle screw fixation is a widely performed surgical procedure for the management of adult spinal deformity. However, there has not been a comprehensive biomechanical study on the different types of fusion levels in terms of stability and possible complications. We aimed to investigate the biomechanical properties of multilevel lumbar fusion according to different types of upper and lower fusion levels. Six different types of fusions were performed using three-dimensional finite element models. Type A and B referred to the group of which upper fusion level was L1 and T10, respectively. Subtype 1, 2, and 3 referred to the group of which lower fusion level was L5, S1, and ilium, respectively (A1, L1-L5; A2, L1-S1; A3, L1-ilium; B1, T10-L5; B2, T10-S1; B3, T10-ilium). Flexion, extension, axial rotation, and lateral bending moments were applied, and the risk of screw loosening and failure and adjacent segment degeneration (ASD) was analyzed. Stress at the bone-screw interface of type B3 was lowest in overall motions. The risk of screw failure showed increasing pattern as the upper and lower levels extended in all motions. Proximal range of motion (ROM) increased as the lower fusion level changed from L5 to S1 and the ilium. For axial rotation, type B3 showed higher proximal ROM (16.2°) than type A3 (11.8°). In multilevel lumbar fusion surgery for adult spinal deformity, adding iliac screws and increasing the fusion level to T10-ilium may lower the risk of screw loosening. In terms of screw failure and proximal ASD, however, T10-ilium fusion has a higher potential risk compared with other fusion types. These results will contribute for surgeons to provide adequate patient education regarding screw failure and proximal ASD, when performing multilevel lumbar fusion.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis

Son

Lee

et al. 2022

BioMed Research International

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“…32 The stiffness of the cage and the match between the cage and the endplate are the major factors need to considered because these parameters play a major role in case of adjacent level disc degeneration. 33 Biswas et al 34 reported that after implantation of single level artificial disc replacement ADR maintains the range of motion closer to natural model and it concludes a low change of disc degeneration after the implant. Rana et al 35 studied posterior dynamic stabilization with flexible rod device and found it is more effective for fusion and maintains the range of motion.…”

Section: Discussionmentioning

confidence: 90%

The biomechanical effects of S-type dynamic cage using Ti and PEEK for ACDF surgery on cervical spine varying loads

Manickam

Roy

2021

Int J Artif Organs

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Anterior cervical discectomy with fusion (ACDF) is the common method to treat the cervical disc degeneration. The most serious problems in the fusion cages are adjacent disc degeneration, loss of lordosis, pain, subsidence, and migration of the cage. The objective of our work is to develop the three-dimensional finite element (FE) model from C3-C6 and virtually implant a designed S-type dynamic cage at C4-C5 segment of the model. The dynamic cage design will provide mobility in the early stage after ACDF surgery. Titanium (Ti) and PEEK (polyether ether ketone) were used as the material property for the cages. We applied the physiological motions at different loads from 0.5, 1, 1.5, 2.0 Nm to evaluate the dynamic cage design and the biomechanical performances of the designed S-type dynamic cage. It was observed that in all the loading condition the range of motion in the adjacent level was maintained and the maximum stress at the adjacent disc was reduced. The clinical significance of the S-type dynamic cage is better stress profile at the fusion level and adjacent segments which translates into higher rate of fusion, lower risk of cage subsidence, lower risk of adjacent segment degeneration, and good mechanical stability.

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“…All the seven ligaments were modelled and meshed with the Link 180 element as per the literature. 21…”

Section: Modellingmentioning

confidence: 99%

The influence of the viscoelastic property of polycarbonate urethane as an artificial disc core material under various physiological motions at the L4–L5 level

Jacob

Prakash

2022

Int J Artif Organs

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Intervertebral disc (IVD) degeneration is one of the musculoskeletal disorders due to the Degenerative Disc Disease (DDD), that cause low back pain (LBP) and leads to a reduced range of motion. Spinal fusion and arthroplasty are the other surgical procedures that could replace the disc affected by DDD against artificial disc replacement (ADR). This study aims to analyse the biomechanical behaviour of proposed core material as Polycarbonate Urethane (PCU) in the L4–L5 lumbar segment for ADR with Ti-6Al-4V and Co-28Cr-6M as endplate materials and compare it to the performance of an ultra-high molecular weight polyethylene (UHMWPE) core. Finite element methods have been approached to measure the overall stress distribution along with other physiological motions like Flexion (FLEX), Extension (EXT), Axial rotation (AR) and Lateral bending (LB), respectively. Preload of 450 N compressive load, 8 N-m for Flex, 6 N-m for EXT, 6 N-m for AR and 4 N-m for LB are applied. It could be concluded that Ti-6Al-4V – PCU and Co-28Cr-6M – PCU is the best composition for the ADR for the L4–L5 level.

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Effect of single and multilevel artificial inter-vertebral disc replacement in lumbar spine: A finite element study

Cited by 14 publications

References 31 publications

Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis

Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis

The biomechanical effects of S-type dynamic cage using Ti and PEEK for ACDF surgery on cervical spine varying loads

The influence of the viscoelastic property of polycarbonate urethane as an artificial disc core material under various physiological motions at the L4–L5 level

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