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Zou Y, Ji S, Yang HW, Ma T, Fang YK, Wang ZC, Liu MM, Zhou PH, Bao ZQ, Zhang CC, Ye YC. Biomechanical Evaluation of 2 Endoscopic Spine Surgery Methods for Treating Lumbar Disc Herniation: A Finite Element Study. Neurospine 2024; 21:273-285. [PMID: 38317559 PMCID: PMC10992651 DOI: 10.14245/ns.2347076.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the effects of 2 endoscopic spine surgeries on the biomechanical properties of normal and osteoporotic spines. METHODS Based on computed tomography images of a healthy adult volunteer, 6 finite element models were created. After validating the normal intact model, a concentrated force of 400 N and a moment of 7.5 Nm were exerted on the upper surface of L3 to simulate 6 physiological activities of the spine. Five types of indices were used to assess the biomechanical properties of the 6 models, range of motion (ROM), maximum displacement value, intervertebral disc stress, maximum stress value, and articular protrusion stress, and by combining them with finite element stress cloud. RESULTS In normal and osteoporotic spines, there was no meaningful change in ROM or disc stress in the 2 surgical models for the 6 motion states. Model N1 (osteoporotic percutaneous transforaminal endoscopic discectomy model) showed a decrease in maximum displacement value of 20.28% in right lateral bending. Model M2 (unilateral biportal endoscopic model) increased maximum displacement values of 16.88% and 17.82% during left and right lateral bending, respectively. The maximum stress value of L4-5 increased by 11.72% for model M2 during left rotation. In addition, using the same surgical approach, ROM, maximum displacement values, disc stress, and maximum stress values were more significant in the osteoporotic model than in the normal model. CONCLUSION In both normal and osteoporotic spines, both surgical approaches were less disruptive to the physiologic structure of the spine. Furthermore, using the same endoscopic spine surgery, normal spine biomechanical properties are superior to osteoporotic spines.
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Affiliation(s)
- Yang Zou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Shuo Ji
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Hui Wen Yang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Tao Ma
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Yue Kun Fang
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Zhi Cheng Wang
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Miao Miao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Ping Hui Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Zheng Qi Bao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Chang Chun Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Yu Chen Ye
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
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Wu W, Yu R, Hao H, Yang K, Jiao G, Liu H. Visible trephine-based foraminoplasty in PTED leads to asymmetrical stress changes and instability in the surgical and adjacent segments: a finite element analysis. J Orthop Surg Res 2023; 18:431. [PMID: 37312161 DOI: 10.1186/s13018-023-03916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
This study aimed to construct a multi-segment lumbar finite element model (FEM) of PTED surgery to analyze the changes in stress and ROM after visible trephine-based foraminoplasty. The CT scans of a 35-year-old healthy male were used to develop a multi-segment lumbar FEM with Mimic, Geomagic Studio, Hypermesh and MSC.Patran. Different foraminoplasty was performed on the model, and these were grouped into normal group (A), the ventral resection group (B), the apex resection group (C), the ventral + apex + isthmus resection group (D), and the SAP + isthmus + lateral recess resection group (E). A vertical load of 500N and a torque of 10N·M were applied to the upper surface of the L3 vertebral body to simulate the biomechanical characteristics under the motion of flexion, extension, lateral bending, and rotation. The von Mises stress maps of the intervertebral f, vertebral body, facet joints, and the ROM of the L3-S1 intervertebral disk were calculated and analyzed. The changes of peak stress on the vertebral body for each group were not significant in the same motion state. Significant stress differences were observed in the L4/5 intervertebral disks, while no obvious stress changes were observed for the L3/4 and L5/S1 intervertebral disks. The stress of the L3/4 and L5/S1 facet joints decreased after L4/5 foraminoplasty, while the stress of L4/5 facet joints displayed an overall increasing trend. Significant asymmetrical stress changes of bilateral facet joints were observed in all three segments, particularly during bilateral rotation movements. The ROM of L3-S1 gradually increased from Group A to Group E, especially during flexion, left lateral bending, and right rotation, with the highest elevation observed for the L45 ROM. Our FEM indicated that enlarged resection and exposure of the articular surface could lead to significant asymmetrical stress changes in the bilateral facet joints and ROM instability of the surgical and adjacent segments. These findings suggested that unnecessary and excessive resection should be avoided in PTED to reduce the incidence of low back pain and the risk of postsurgical degeneration.
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Affiliation(s)
- Wenliang Wu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
- Department of Physician Training, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Ruixuan Yu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Hongkai Hao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Kaiyun Yang
- Institute of Stomatology, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Guangjun Jiao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Haichun Liu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China.
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Huang C, Liu Z, Wei Z, Fang Z, Xi Z, Cai P, Li J. Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study. Front Surg 2023; 9:1004642. [PMID: 36713678 PMCID: PMC9877423 DOI: 10.3389/fsurg.2022.1004642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background The fixation-induced biomechanical deterioration will increase the risk of adjacent segment diseases (ASD) after lumbar interbody fusion with Bilateral pedicle screw (BPS) fixation. The accurate adjustment of insertional pedicle screw positions is possible, and published studies have reported its mechanical effects. However, no studies clarified that adjusting insertional screw positions would affect the postoperative biomechanical environment and the risk of ASD. The objective of this study was to identify this issue and provide theoretical references for the optimization of insertional pedicle screw position selections. Methods The oblique lumbar interbody fusion fixed by BPS with different insertional positions has been simulated in the L4-L5 segment of our previously constructed and validated lumbosacral model. Biomechanical indicators related to ASD have been computed and recorded under flexion, extension, bending, and axial rotation loading conditions. Results The change of screw insertional positions has more apparent biomechanical effects on the cranial than the caudal segment. Positive collections can be observed between the reduction of the fixation length and the alleviation of motility compensation and stress concentration on facet cartilages. By contrast, no pronounced tendency of stress distribution on the intervertebral discs can be observed with the change of screw positions. Conclusions Reducing the fixation stiffness by adjusting the insertional screw positions could alleviate the biomechanical deterioration and be an effective method to reduce the risk of ASD caused by BPS.
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Affiliation(s)
- Chenyi Huang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zongchao Liu
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhangchao Wei
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, China
| | - Zhipeng Xi
- Department of Spine Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Ping Cai
- Department of Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China,Correspondence: Jingchi Li Ping Cai
| | - Jingchi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China,Correspondence: Jingchi Li Ping Cai
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Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z, Wang N, Xie L, Song Y. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskelet Disord 2021; 22:616. [PMID: 34246272 PMCID: PMC8272903 DOI: 10.1186/s12891-021-04504-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.
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Affiliation(s)
- Jingchi Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China
| | - Chen Xu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Mengnan Liu
- Macau University of Science and Technology, Macau, 999078, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, 610039, China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China.
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Shi Z, Shi L, Chen X, Liu J, Wu H, Wang C, Chen Z, Yang F, Yu S, Pang Q. The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine. J Orthop Surg Res 2021; 16:391. [PMID: 34140040 PMCID: PMC8212469 DOI: 10.1186/s13018-021-02540-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV
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Affiliation(s)
- Zewen Shi
- Ningbo University School of Medicine, Ningbo, China
| | - Lin Shi
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Xianjun Chen
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Jiangtao Liu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Haihao Wu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Chenghao Wang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Zeming Chen
- Ningbo University School of Medicine, Ningbo, China
| | - Fang Yang
- Ningbo University School of Medicine, Ningbo, China
| | - Sheng Yu
- Ningbo University School of Medicine, Ningbo, China
| | - Qingjiang Pang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China.
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