Minimally invasive transforaminal and anterior lumbar interbody fusion surgery at level L5-S1

Purpose: Little is known about the biomechanical performance of L5-S2 alar internal fixation constructs after posterior lumbar interbody fusion. This study aimed to compare the biomechanical effect of L5-S1 internal fixation and L5-S2 alar internal fixation on severe lumbar spondylolisthesis. Methods: A normal male volunteer without a history of spinal disease was selected, lumbar CT data was collected. An intact L5-S2 three-dimensional finite element model was created by Mimics and Geomagic.Two kinds of fixation methods were reconstructed including (1) the L5-S1 screw fixation model and (2) the L5-S2 alar fixation model. The inverse repair was performed using Geomagic software, the internal fixation device was drawn using Creo software, and the model parameters were set and analyzed using ANSYS Workbench software. Results: The validity of the intact model shows that the ROM of the model is similar to that of a reported cadaveric study. The average stress of the L5-S2 alar internal fixation device was 86.9-111% higher(P＜0.001) than that of the L5-S1 fixation device when the bone of the S1 screw path reached the yield threshold. The maximal stress of the S1 screw in the L5-S2 alar fixation was significantly lower (P＜0.001) than it in the L5-S1 fixation when the stress exceeds the S1 bone yield threshold. When the S1 screw path bone yielded, the maximal deformation value of the S1 screw path was similar in both models (P>0.05), while the average deformation value of the S1 screw path in L5-S2 alar fixation was significantly higher (P＜0.01) than it in L5-S1 fixation. Conclusion: Extending fixation to the S2 wing can significantly improve internal fixation device stability and reduce the risk of intraoperative and postoperative fractures while avoiding injury to the sacroiliac joint, reducing the difficulty of surgery and the risk of injury to surrounding tissues. It is a reasonable plan for the treatment of moderate and severe lumbar spondylolisthesis with osteoporosis.

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“…2) [13] . The material properties of the various spinal components were derived from the literature [16][17][18][19] , as speci ed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of S2 alar and traditional S1 pedicle fixation for severe lumbar spondylolisthesis in different bone mineral densities: a finite element analysis

Wang

Chen

Yang

et al. 2020

Preprint

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“…Nonlinear FE models of the human vertebra have been validated in several studies using various methods [9,10]. In this study, the reliability of FE models was validated via comparisons between the FE models reported in extant studies and models proposed in this paper [11,12].…”

Section: Introductionmentioning

confidence: 94%

Numerical Evaluation of Spinal Stability after Posterior Spinal Fusion with Various Fixation Segments and Screw Types in Patients with Osteoporotic Thoracolumbar Burst Fracture Using Finite Element Analysis

et al. 2021

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The aim of this study was to analyze the spinal stability and safety after posterior spinal fusion with various fixation segments and screw types in patients with an osteoporotic thoracolumbar burst fracture based on finite element analysis (FEA). To realize various osteoporotic vertebral fracture conditions on T12, seven cases of Young’s modulus, namely 0%, 1%, 5%, 10%, 25%, 50%, and 100% of the Young’s modulus, for vertebral bones under intact conditions were considered. Four types of fixation for thoracolumbar fracture on T12 (fixed with T11-L1, T10-T11-L1, T11-L1-L2, and T10-T11-L1-L2) were applied to the thoracolumbar fusion model. The following screw types were considered: pedicle screw (PS) and cortical screw (CS). Using FEA, four motions were performed on the fixed spine, and the stress applied to the screw, peri-implant bone (PIB), and intervertebral disc (IVD) and the range of motion (ROM) were calculated. The lowest ROM calculated corresponded to the T10-T11-L1-L2 model, while the closest to the intact situation was achieved in the T11-L1-L2 fixation model using PS. The lowest stress in the screw and PB was detected in the T10-T11-L1-L2 fixation model.

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“…MIS-TLIF better preserves the lumbar spinous process, interspinous ligament, and local blood supply of the psoas muscle, which is more conducive to the recovery of patients after surgery. In MIS-TLIF, by moving the working channel inward, the decompression range is expanded, and effective decompression can also be performed for part of the lumbar central canal stenosis [ 13 , 14 ]. It also avoids stripping and excessive stretching of the paraspinal muscles on both sides, retains the structural function of the posterior tension band of the lumbar spine, increases the biomechanical stability of the spine, and effectively reduces the formation of low back muscle atrophy and soft tissue scars, which is beneficial to the recovery of back muscle function reduces the incidence of low back pain after surgery, shortens the time for patients to go to the ground, and also reduces the economic burden of patients.…”

Section: Analysis Of Mis⁃tlif and Tlifmentioning

confidence: 99%

Comparison of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion and TLIF for Treatment of Lumbar Spine Stenosis

Gao

Cao

et al. 2022

Journal of Healthcare Engineering

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With the development of minimally invasive technology, minimally invasive surgery transforaminal lumbar interbody fusion has become an effective way to treat lumbar spinal stenosis. Lumbar spinal stenosis is one of the common diseases that cause backache or lumbago and sciatica. This article compares and analyzes the clinical efficacy of 60 patients with lumbar spinal stenosis surgery. It can be seen that the wound by MIS-TLIF is significantly less than that of traditional open surgery, and the postoperative recovery of MIS-TLIF is faster. So, MIS-TLIF is one of the concepts of minimally invasive surgery. The age distribution ranged from 56 to 78 years, with an average of 65.7 years. 31 cases were treated with MIS-TLIF (MIS-TLIF group), and 29 were treated with traditional posterior open surgery (TLIF group). The operation time, intraoperative blood loss, and postoperative drainage of the operation area were recorded. After statistical testing, the intraoperative blood loss, incision size, and postoperative drainage volume of the wound in the MIS-TLIF group were significantly less than those in the TLIF group. The results of JOA score, ODI score, and VAS score during the postoperative follow-up period were comparable to those of open surgery. Therefore, minimally invasive transforaminal lumbar interbody fusion is effective in treating lumbar spinal stenosis.

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Minimally invasive transforaminal and anterior lumbar interbody fusion surgery at level L5-S1

Cited by 6 publications

References 22 publications

Evaluation of S2 alar and traditional S1 pedicle fixation for severe lumbar spondylolisthesis in different bone mineral densities: a finite element analysis

Evaluation of S2 alar and traditional S1 pedicle fixation for severe lumbar spondylolisthesis in different bone mineral densities: a finite element analysis

Numerical Evaluation of Spinal Stability after Posterior Spinal Fusion with Various Fixation Segments and Screw Types in Patients with Osteoporotic Thoracolumbar Burst Fracture Using Finite Element Analysis

Comparison of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion and TLIF for Treatment of Lumbar Spine Stenosis

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