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Biomechanical and clinical studies on lumbar spine fusion surgery: a review. Med Biol Eng Comput 2023; 61:617-634. [PMID: 36598676 DOI: 10.1007/s11517-022-02750-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Low back pain is associated with degenerative disc diseases of the spine. Surgical treatment includes fusion and non-fusion types. The gold standard is fusion surgery, wherein the affected vertebral segment is fused. The common complication of fusion surgery is adjacent segment degeneration (ASD). The ASD often leads to revision surgery, calling for a further fusion of adjacent segments. The existing designs of nonfusion type implants are associated with clinical problems such as subsidence, difficulty in implantation, and the requirement of revision surgeries. Various surgical approaches have been adopted by the surgeons to insert the spinal implants into the affected segment. Over the years, extensive biomechanical investigations have been reported on various surgical approaches and prostheses to predict the outcomes of lumbar spine implantations. Computer models have been proven to be very effective in identifying the best prosthesis and surgical procedure. The objective of the study was to review the literature on biomechanical studies for the treatment of lumbar spinal degenerative diseases. A critical review of the clinical and biomechanical studies on fusion spine surgeries was undertaken. The important modeling parameters, challenges, and limitations of the current studies were identified, showing the future research directions.
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Gennari A, Langlais T, Litrico S, Persohn S, Allain J, Skalli W. Biomechanical specimen assessment by low dose biplanar X-ray study of fusion constructions using a posterior lumbar cage with integrated anchors and posterior adjunctive fixators. Comput Methods Biomech Biomed Engin 2021; 25:536-542. [PMID: 34392764 DOI: 10.1080/10255842.2021.1966625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective was to compare L4/5 range of motions of fusion constructs using anchored cages. Twelve human cadaveric spine were tested in intact condition, and divided into TLIF and PLIF groups. Testing consisted in applying pure moments in flexion-extension, lateral bending and axial rotation. The computation of intersegmental motion was assessed using 3 D biplanar radiographs. In TLIF group, the addition of contralateral transfacet decreased flexion-extension motion (39%; p = 0.036) but without difference with the ipsilateral pedicle screw construction (53%; p = 0.2). In PLIF group, the addition of interspinous anchor reduced flexion-extension motion (12%; p = 0.036) but without difference with the bilateral pedicle screw construction (17%; p = 0.8).
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Affiliation(s)
- A Gennari
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Neurosurgery, Spine Unit, CHU, Nice, France
| | - T Langlais
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Département Othopédie Pédiatrique, Hôpital des Enfants, Purpan, Toulouse Université, France
| | - S Litrico
- Neurosurgery, Spine Unit, CHU, Nice, France
| | - S Persohn
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - J Allain
- Orthopedic Surgery, Spine Unit, Clinique Geoffroy Saint-Hilaire, Paris, France
| | - W Skalli
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
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Chang CW, Chung YH, Chang CJ, Chen YN, Li CT, Chang CH, Peng YT. Computational comparison of bone cement and poly aryl-ether-ether-ketone spacer in single-segment posterior lumbar interbody fusion: a pilot study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00832-8. [PMID: 31834586 DOI: 10.1007/s13246-019-00832-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022]
Abstract
Posterior lumbar interbody fusion (PLIF) with a spacer and posterior instrument (PI) via minimally invasive surgery (MIS) restores intervertebral height in degenerated disks. To align with MIS, the spacer has to be shaped with a slim geometry. However, the thin spacer increases the subsidence and migration after PLIF. This study aimed to propose a new lumbar fusion approach using bone cement to achieve a larger supporting area than that achieved by the currently used poly aryl-ether-ether-ketone (PEEK) spacer and assess the feasibility of this approach using a sawbone model. Furthermore, the mechanical responses, including the range of motion (ROM) and bone stress with the bone cement spacer were compared to those noted with the PEEK spacer by finite element (FE) simulation. An FE lumbar L3-L4 model with PEEK and bone cement spacers and PI was developed. Four fixing conditions were considered: intact lumbar L3-L4 segment, lumbar L3-L4 segment with PI, PEEK spacer plus PI, and bone cement spacer plus PI. Four kinds of 10-NM moments (flexion, extension, lateral bending, and rotation) and two different bone qualities (normal and osteoporotic) were considered. The bone cement spacer yielded smaller ROMs in extension and rotation than the PEEK spacer, while the ROMs of the bone cement spacer in flexion and lateral bending were slightly greater than with the PEEK spacer. Compared with the PEEK spacer, peak contact pressure on the superior surface of L4 with the bone cement spacer in rotation decreased by 74% (from 8.68 to 2.25 MPa) and 69.1% (from 9.1 to 2.82 MPa), respectively, in the normal and osteoporotic bone. Use of bone cement as a spacer with PI is a potential approach to decrease the bone stress in lumbar fusion and warrants further research.
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Affiliation(s)
- Chih-Wei Chang
- Department of BioMedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Chung
- Department of Orthopedics, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Chia-Jung Chang
- Department of BioMedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Nien Chen
- Department of Physical Therapy, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
| | - Chun-Ting Li
- Institute of Geriatric Welfare Technology & Science, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 25245, Taiwan.
| | - Chih-Han Chang
- Department of BioMedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Te Peng
- Department of BioMedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Metal Industries Research & Development Centre, Kaohsiung City, Taiwan
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