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Huang Y, Maimaiti A, Tian Y, Li Z, Kahaer A, Rexiti P. Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis. J Orthop Surg Res 2023; 18:549. [PMID: 37525283 PMCID: PMC10388474 DOI: 10.1186/s13018-023-04027-6] [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: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To compare the biomechanical performance of the hybrid lumbar fixation technique with the traditional and cortical bone trajectory techniques using the finite element method. METHODS Four adult wet lumbar spine specimens were provided by the Department of Anatomy and Research of Xinjiang Medical University, and four L1-S1 lumbar spine with transforaminal lumbar interbody fusion (TLIF) models at L4-L5 segment and four different fixation techniques were established: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT (CBT screws at L4 and TT screws at L5) and TT-CBT (TT screws at L4 and CBT screws at L5). The range of motion (ROM) of the L4-L5 segment, von Mises stress of cage, internal fixation, and rod were compared in flexion, extension, left and right bending, and left and right rotation. RESULTS Compared with the TT-TT group, the TT-CBT group exhibited lower ROM of L4-L5 segment, especially in left-sided bending; the CBT-TT group had the lowest ROM of L4-L5 segment in flexion and extension among the four fixation methods. Compared with the CBT-CBT group, the peak cage stress in the TT-CBT group was reduced by 9.9%, 18.1%, 21.5%, 23.3%, and 26.1% in flexion, left bending, right bending, left rotation, and right rotation conditions, respectively, but not statistically significant (P > 0.05). The peak stress of the internal fixation system in the TT-CBT group was significantly lower than the other three fixation methods in all five conditions except for extension, with a statistically significant difference between the CBT-TT and TT-CBT groups in the left rotation condition (P = 0.017). In addition, compared with the CBT-CBT group, the peak stress of the rod in the CBT-TT group decreased by 34.8%, 32.1%, 28.2%, 29.3%, and 43.0% under the six working conditions of flexion, extension, left bending, left rotation, and right rotation, respectively, but not statistically significant (P > 0.05). CONCLUSIONS Compared with the TT-TT and CBT-CBT fixation methods in TLIF, the hybrid lumbar fixation CBT-TT and TT-CBT techniques increase the biomechanical stability of the internal fixation structure of the lumbar fusion segment to a certain extent and provide a corresponding theoretical basis for further development in the clinic.
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Affiliation(s)
- Ying Huang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | | | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
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Nikkhoo M, Chen WC, Lu ML, Fu CJ, Niu CC, Lien HY, Cheng CH. Anatomical parameters alter the biomechanical responses of adjacent segments following lumbar fusion surgery: Personalized poroelastic finite element modelling investigations. Front Bioeng Biotechnol 2023; 11:1110752. [PMID: 36860879 PMCID: PMC9968854 DOI: 10.3389/fbioe.2023.1110752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction: While the short-term post-operative outcome of lumbar fusion is satisfying for most patients, adjacent segment disease (ASD) can be prevalent in long-term clinical observations. It might be valuable to investigate if inherent geometrical differences among patients can significantly alter the biomechanics of adjacent levels post-surgery. This study aimed to utilize a validated geometrically personalized poroelastic finite element (FE) modeling technique to evaluate the alteration of biomechanical response in adjacent segments post-fusion. Methods: Thirty patients were categorized for evaluation in this study into two distinct groups [i.e., 1) non-ASD and 2) ASD patients] based on other long-term clinical follow-up investigations. To evaluate the time-dependent responses of the models subjected to cyclic loading, a daily cyclic loading scenario was applied to the FE models. Different rotational movements in different planes were superimposed using a 10 Nm moment after daily loading to compare the rotational motions with those at the beginning of cyclic loading. The biomechanical responses of the lumbosacral FE spine models in both groups were analyzed and compared before and after daily loading. Results: The achieved comparative errors between the FE results and clinical images were on average below 20% and 25% for pre-op and post-op models, respectively, which confirms the applicability of this predictive algorithm for rough pre-planning estimations. The results showed that the disc height loss and fluid loss were increased for the adjacent discs in post-op models after 16 h of cyclic loading. In addition, significant differences in disc height loss and fluid loss were observed between the patients who were in the non-ASD and ASD groups. Similarly, the increased stress and fiber strain in the annulus fibrosus (AF) was higher in the adjacent level of post-op models. However, the calculated stress and fiber strain values were significantly higher for patients with ASD. Discussion: Evaluating the biomechanical response of pre-op and post-op modeling in the non-ASD and ASD groups showed that the inherent geometric differences among patients cause significant variations in the estimated mechanical response. In conclusion, the results of the current study highlighted the effect of geometrical parameters (which may refer to the anatomical conditions or the induced modifications regarding surgical techniques) on time-dependent responses of lumbar spine biomechanics.
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Affiliation(s)
- Mohammad Nikkhoo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Wen-Chien Chen
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Ling Lu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Ju Fu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hen-Yu Lien
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan,*Correspondence: Chih-Hsiu Cheng,
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Zhu J, Shen H, Cui Y, Fogel GR, Liao Z, Liu W. Biomechanical Evaluation of Transforaminal Lumbar Interbody Fusion with Coflex-F and Pedicle Screw Fixation: Finite Element Analysis of Static and Vibration Conditions. Orthop Surg 2022; 14:2339-2349. [PMID: 35946442 PMCID: PMC9483060 DOI: 10.1111/os.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/02/2022] [Accepted: 07/02/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the biomechanics of transforaminal lumbar interbody fusion (TLIF) with interspinous process device (IPD) or pedicle screw fixation under both static and vibration conditions by the finite element (FE) method. METHOD A validated FE model of the L1-5 lumbar spine was used in this study. This FE model derived from computed tomography images of a healthy female adult volunteer of appropriate age. Then the model was modified to simulate L3-4 TLIF. Four conditions were compared: (i) intact; (ii) TLIF combined with bilateral pedicle screw fixation (BPSF); (iii) TLIF combined with U-shaped IPD Coflex-F (CF); and (iv) TLIF combined with unilateral pedicle screw fixation (UPSF). The intact and surgical FE models were analyzed under static and vibration loading conditions respectively. For static loading conditions, four motion modes (flexion, extension, lateral bending, and axial rotation) were simulated. For vibration loading conditions, the dynamic responses of lumbar spine under sinusoidal vertical load were simulated. RESULT Under static loading conditions, compared with intact case, BPSF decreased range of motion (ROM) by 92%, 95%, 89% and 92% in flexion, extension, lateral bending and axial rotation, respectively. While CF decreased ROM by 87%, 90%, 69% and 80%, and UPSF decreased ROM by 84%, 89%, 66% and 82%, respectively. Compared with CF, UPSF increased the endplate stress by 5%-8% in flexion, 7%-10% in extension, 2%-4% in lateral bending, and decreased the endplate stress by 16%-19% in axial rotation. Compared with CF, UPSF increased the cage stress by 9% in flexion, 10% in extension, and decreased the cage stress by 3% in lateral bending, and 13% in axial rotation. BPSF decreased the stress responses of endplates and cage compared with CF and UPSF. Compared BPSF, CF decreased the facet joint force (FJF) by 6%-13%, and UPSF decreased the FJF by 4%-12%. During vibration loading conditions, compared with BPSF, CF reduced maximum values of the FJF by 16%-32%, and vibration amplitudes by 22%-35%, while UPSF reduced maximum values by 20%-40%, and vibration amplitudes by 31%-45%. CONCLUSION Compared with other surgical models, BPSF increased the stability of lumbar spine, and also showed advantages in cage stress and endplate stress. CF showed advantages in IDP and FJF especially during vertical vibration, which may lead to lower risk of adjacent segment degeneration. CF may be an effective alternative to pedicle screw fixation in TLIF procedures.
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Affiliation(s)
- Jia Zhu
- Tsinghua Shenzhen International Graduate SchoolTsinghua UniversityShenzhenChina,Department of Mechanical EngineeringTsinghua UniversityBeijingChina,Biomechanics and Biotechnology LabResearch Institute of Tsinghua University in ShenzhenShenzhenChina
| | - Hangkai Shen
- Department of Mechanical EngineeringTsinghua UniversityBeijingChina,Biomechanics and Biotechnology LabResearch Institute of Tsinghua University in ShenzhenShenzhenChina
| | - Yangyang Cui
- Tsinghua Shenzhen International Graduate SchoolTsinghua UniversityShenzhenChina,Department of Mechanical EngineeringTsinghua UniversityBeijingChina,Biomechanics and Biotechnology LabResearch Institute of Tsinghua University in ShenzhenShenzhenChina
| | | | - Zhenhua Liao
- Biomechanics and Biotechnology LabResearch Institute of Tsinghua University in ShenzhenShenzhenChina
| | - Weiqiang Liu
- Tsinghua Shenzhen International Graduate SchoolTsinghua UniversityShenzhenChina,Department of Mechanical EngineeringTsinghua UniversityBeijingChina,Biomechanics and Biotechnology LabResearch Institute of Tsinghua University in ShenzhenShenzhenChina
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Khalaf K, Nikkhoo M. Comparative biomechanical analysis of rigid vs. flexible fixation devices for the lumbar spine: A geometrically patient-specific poroelastic finite element study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 212:106481. [PMID: 34736171 DOI: 10.1016/j.cmpb.2021.106481] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Lumbar spinal stenosis (LSS), or the narrowing of the spinal canal, continues to be the leading preoperative diagnosis for adults older than 65 years who undergo spine surgery. Although the treatment of LSS depends on its severity, the optimal surgical technique towards decreasing the risk of adjacent segment disease (ASD) remains elusive. This study aimed to comparatively analyze spinal biomechanics with rigid and flexible fixation devices (i.e., rigid and dynamic posterolateral fusion (PLF) and interspinous process (ISP) devices) during daily activities. METHODS Using a validated parametric poroelastic finite element modeling approach, 8 subject-specific pre-operative models were developed, and their validity was evaluated. Parametric FE models of the lumbar spines were then regenerated based on post-operation images for (A) rigid PLF (B) dynamic PLF (C) rigid ISP device (Coflex) and (D) flexible ISP device (DIAM) at L4-L5 level. Biomechanical responses for instrumented and adjacent intervertebral discs (IVDs) were analyzed and compared subject to static and cyclic loading. RESULTS The preoperative models were well comparable with previous works in literature. The postoperative results for the PLF and Coflex rigid systems, demonstrated greater ROM; higher values of stress and strain in the AF region; and increased disc height and fluid loss at the adjacent levels, as compared with the pre-op models and the post-op results of the flexible systems (i.e., dynamic PLF and DIAM). The calculated forces on the facet joint were of smaller magnitude for the ISP devices as compared to the PLF, particularly during extension. CONCLUSIONS This study demonstrates that the dynamic PLF construct and DIAM implants could be effective to maintain the natural poroelastic characteristics of adjacent IVDs, which could be beneficial for enhancing long-term clinical outcomes. FEM provides clinicians with an invaluable patient-specific quantitative tool for informed surgical planning and discerning follow-up management.
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Affiliation(s)
- Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, and Health Engineering Innovation Center, PO Box 127788, Abu Dhabi, United Arab Emirates.
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Nikkhoo M, Lu ML, Chen WC, Fu CJ, Niu CC, Lin YH, Cheng CH. Biomechanical Investigation Between Rigid and Semirigid Posterolateral Fixation During Daily Activities: Geometrically Parametric Poroelastic Finite Element Analyses. Front Bioeng Biotechnol 2021; 9:646079. [PMID: 33869156 PMCID: PMC8047206 DOI: 10.3389/fbioe.2021.646079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
While spinal fusion using rigid rods remains the gold standard treatment modality for various lumbar degenerative conditions, its adverse effects, including accelerated adjacent segment disease (ASD), are well known. In order to better understand the performance of semirigid constructs using polyetheretherketone (PEEK) in fixation surgeries, the objective of this study was to analyze the biomechanical performance of PEEK versus Ti rods using a geometrically patient-specific poroelastic finite element (FE) analyses. Ten subject-specific preoperative models were developed, and the validity of the models was evaluated with previous studies. Furthermore, FE models of those lumbar spines were regenerated based on postoperation images for posterolateral fixation at the L4–L5 level. Biomechanical responses for instrumented and adjacent intervertebral discs (IVDs) were analyzed and compared subjected to static and cyclic loading. The preoperative model results were well comparable with previous FE studies. The PEEK construct demonstrated a slightly increased range of motion (ROM) at the instrumented level, but decreased ROM at adjacent levels, as compared with the Ti. However, no significant changes were detected during axial rotation. During cyclic loading, disc height loss, fluid loss, axial stress, and collagen fiber strain in the adjacent IVDs were higher for the Ti construct when compared with the intact and PEEK models. Increased ROM, experienced stress in AF, and fiber strain at adjacent levels were observed for the Ti rod group compared with the intact and PEEK rod group, which can indicate the risk of ASD for rigid fixation. Similar to the aforementioned pattern, disc height loss and fluid loss were significantly higher at adjacent levels in the Ti rod group after cycling loading which alter the fluid–solid interaction of the adjacent IVDs. This phenomenon debilitates the damping quality, which results in disc disability in absorbing stress. Such finding may suggest the advantage of using a semirigid fixation system to decrease the chance of ASD.
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Affiliation(s)
- Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Meng-Ling Lu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Chien Chen
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Ju Fu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chien Niu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yang-Hua Lin
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiu Cheng
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Biomechanical modelling of the facet joints: a review of methods and validation processes in finite element analysis. Biomech Model Mechanobiol 2020; 20:389-401. [PMID: 33221991 PMCID: PMC7979651 DOI: 10.1007/s10237-020-01403-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
There is an increased interest in studying the biomechanics of the facet joints. For in silico studies, it is therefore important to understand the level of reliability of models for outputs of interest related to the facet joints. In this work, a systematic review of finite element models of multi-level spinal section with facet joints output of interest was performed. The review focused on the methodology used to model the facet joints and its associated validation. From the 110 papers analysed, 18 presented some validation of the facet joints outputs. Validation was done by comparing outputs to literature data, either computational or experimental values; with the major drawback that, when comparing to computational values, the baseline data was rarely validated. Analysis of the modelling methodology showed that there seems to be a compromise made between accuracy of the geometry and nonlinearity of the cartilage behaviour in compression. Most models either used a soft contact representation of the cartilage layer at the joint or included a cartilage layer which was linear elastic. Most concerning, soft contact models usually did not contain much information on the pressure-overclosure law. This review shows that to increase the reliability of in silico model of the spine for facet joints outputs, more needs to be done regarding the description of the methods used to model the facet joints, and the validation for specific outputs of interest needs to be more thorough, with recommendation to systematically share input and output data of validation studies.
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Lu T, Lu Y. Interlaminar stabilization offers greater biomechanical advantage compared to interspinous stabilization after lumbar decompression: a finite element analysis. J Orthop Surg Res 2020; 15:291. [PMID: 32727615 PMCID: PMC7392677 DOI: 10.1186/s13018-020-01812-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interlaminar stabilization and interspinous stabilization are two newer minimally invasive methods for lumbar spine stabilization, used frequently in conjunction with lumbar decompression to treat lumbar stenosis. The two methods share certain similarities, therefore, frequently being categorized together. However, the two methods offer distinct biomechanical properties, which affect their respective effectiveness and surgical success. OBJECTIVE To compare the biomechanical characteristics of interlaminar stabilization after lumbar decompression (ILS) and interspinous stabilization after lumbar decompression (ISS). For comparison, lumbar decompression alone (DA) and decompression with instrumented fusion (DF) were also included in the biomechanical analysis. METHODS Four finite element models were constructed, i.e., DA, DF, ISS, and ILS. To minimize device influence and focus on the biomechanical properties of different methods, Coflex device as a model system was placed at different position for the comparison of ISS and ILS. The range of motion (ROM) and disc stress peak at the surgical and adjacent levels were compared among the four surgical constructs. The stress peak of the spinous process, whole device, and device wing was compared between ISS and ILS. RESULTS Compared with DA, the ROM and disc stress at the surgical level in ILS or ISS were much lower in extension. The ROM and disc stress at the surgical level in ILS were 1.27° and 0.36 MPa, respectively, and in ISS 1.51°and 0.55 MPa, respectively in extension. This is compared with 4.71° and 1.44 MPa, respectively in DA. ILS (2.06-4.85° and 0.37-0.98 MPa, respectively) or ISS (2.07-4.78° and 0.37-0.98 MPa, respectively) also induced much lower ROM and disc stress at the adjacent levels compared with DF (2.50-7.20° and 0.37-1.20 MPa, respectively). ILS further reduced the ROM and disc stress at the surgical level by 8% and 25%, respectively, compared to ISS. The stress peak of the spinous process in ILS was significantly lower than that in ISS (13.93-101 MPa vs. 31.08-172.5 MPa). In rotation, ILS yielded a much lower stress peak in the instrumentation wing than ISS (128.7 MPa vs. 222.1 MPa). CONCLUSION ILS and ISS partly address the issues of segmental instability in DA and hypermobility and overload at the adjacent levels in DF. ILS achieves greater segmental stability and results in a lower disc stress, compared to ISS. In addition, ILS reduces the risk of spinous process fracture and device failure.
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Affiliation(s)
- Teng Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, BTM 4th floor, Boston, MA, 02115, USA.,Department of Orthopedics, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, BTM 4th floor, Boston, MA, 02115, USA.
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