Finite element analysis in adjacent segment degeneration after lumbar fusion

Yan, Jia-Zhi; Qiu, Guixing; Wu, Zhihong; Wang, Xuesong; Xing, Ze-Jun

doi:10.1002/rcs.374

Cited by 29 publications

(9 citation statements)

References 16 publications

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“…Postoperative adjacent segment degeneration developed more frequently in patients who had advanced disc degeneration preoperatively, it has been confirmed by both clinical case study and biomechanical analysis. [ 19 , 28 – 30 ] Anandjiwala et al [ 19 ] prospectively reviewed 74 consecutive patients who underwent instrumented lumbar/lumbosacral fusion with a minimum follow-up of 5 years, and demonstrated that patients with preoperative disc degeneration at an adjacent level were more at risk for the development of adjacent segment degeneration. In the present study, we confirm that preoperative disc degeneration at adjacent level was a significant risk factor for postoperative ASD (Fig.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders

et al. 2017

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The purpose of this study was to explore incidence and risk factors of adjacent segment disease (ASD) following posterior decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for both spinal surgeon and surgically treated patients.By retrieving the medical records from January 2011 to December 2013 in our hospital, 237 patients were retrospectively reviewed. According to the occurrence of ASD at follow up, patients were divided into 2 groups: ASD and N-ASD group. To investigate risk values for the occurrence of ASD, 3 categorized factors were analyzed statistically: Patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), duration. Surgical variables: surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, intraoperative superior facet joint violation. Radiographic parameters: preoperative lumbar lordosis, preoperative angular motion at adjacent segment, preoperative adjacent segment disc degeneration, preoperative paraspinal muscle degeneration.Postoperative ASD was developed in 15 of 237 patients (6.3%) at final follow up. There was no statistically significant difference between the 2 groups in patient characteristics of age, sex composition, BMD, duration, while the BMI was higher in ASD group than that in N-ASD group. There was no difference in surgical variables of surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, while intraoperative superior facet joint violation was more common in ASD group than that in N-ASD group. There was no difference in radiographic parameters of preoperative lumbar lordosis, preoperative paraspinal muscle degeneration, while preoperative adjacent segment disc degeneration were more severe in ASD group than that in N-ASD group. The Logistic regression analysis revealed that, BMI >25 kg/m2, preoperative disc degeneration, and superior facet joint violation were independently associated with ASD.In conclusion, higher BMI, preoperative disc degeneration at adjacent segment and intraoperative superior facet joint violation are risk factors for ASD. Patients who are overweight or obesity and with preoperative disc degeneration at adjacent segment should be fully informed the risk of ASD. For surgeons, it is essential to prevent superior facet joint violation in pedicle screw insertion procedure.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders

et al. 2017

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“…The mechanical consequences of disc degeneration and the treatments meant to address it are often investigated with finite element analysis (FEA). However, due to lack of multi-subject 3D shape information in the literature, investigators typically use a 3D geometry from on a single subject (El-Rich et al, 2008; Rundell et al, 2009) or a simplified geometry extrapolated from vertebral bone morphometry (point-to-point distances) (Kim et al, 2001; Kim, 2000; Meijer et al, 2011; Meijer et al, 2010; Niemeyer et al, 2012; Panjabi et al, 1992; Rohlmann et al, 2006; Rundell et al, 2009; Smit, 1996; Yan et al, 2011). Morphometry of the disc itself is also available, based on 2D mid-sagittal MRI (Boos et al, 1996; Fujiwara et al, 2000; Kwok et al, 2012) or dissected discs (Beckstein et al, 2008; Brinckmann and Grootenboer, 1991; Keller et al, 1987; Nachemson et al, 1979; O’Connell et al, 2007; Porter et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

Human L3L4 intervertebral disc mean 3D shape, modes of variation, and their relationship to degeneration

Peloquin

Yoder

Jacobs

et al. 2014

Journal of Biomechanics

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Intervertebral disc mechanics are affected by both disc shape and disc degeneration, which in turn each affect the other; disc mechanics additionally have a role in the etiology of disc degeneration. Finite element analysis (FEA) is a favored tool to investigate these relationships, but limited data for intervertebral disc 3D shape has forced the use of simplified or single-subject geometries, with the effect of inter-individual shape variation investigated only in specialized studies. Similarly, most data on disc shape variation with degeneration is based on 2D mid-sagittal images, which incompletely define 3D shape changes. Therefore, the objective of this study was to quantify inter-individual disc shape variation in 3D, classify this variation into independently-occurring modes using a statistical shape model, and identify correlations between disc shape and degeneration. Three-dimensional disc shapes were obtained from MRI of 13 human male cadaver L3L4 discs. An average disc shape and four major modes of shape variation (representing 90% of the variance) were identified. The first mode represented disc axial area and was significantly correlated to degeneration (R2 = 0.44), indicating larger axial area in degenerate discs. Disc height variation occurred in three distinct modes, each also involving non-height variation. The statistical shape model provides an average L3L4 disc shape for FEA that is fully defined in 3D, and makes it convenient to generate a set of shapes with which to represent aggregate inter-individual variation. Degeneration grade-specific shapes can also be generated. To facilitate application, the model is included in this paper’s supplemental content.

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“…Les rotations du segment lombaire augmentent les contraintes au niveau de l'annulus, surtout en torsion axiale, et sont majorées lorsque les déplacements sont combinés dans plusieurs plans 154,192 . L'arthrodèse lombaire augmente les contraintes aux segments adjacents, surtout lorsque le disque présente déjà une discopathie modérée 203 documentée par des radiographies de face et de profil (Fig. 42).…”

Section: Discussionunclassified

Influence of an Auxiliary Facet System on Lumbar Spine Biomechanics

Charles

Persohn

Steib

et al. 2011

Spine

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Finite element analysis in adjacent segment degeneration after lumbar fusion

Abstract: The preoperative degeneration of the adjacent segment of the disc is a significant risk factor for ASD.

Cited by 29 publications

References 16 publications

Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders

Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders

Human L3L4 intervertebral disc mean 3D shape, modes of variation, and their relationship to degeneration

Influence of an Auxiliary Facet System on Lumbar Spine Biomechanics

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