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Li Q, Zhao H, Yang J, Song S, Liu X. Optimization of Pedicle Screw Parameters for Enhancing Implant Stability Based on Finite Element Analysis. World Neurosurg 2024; 183:e345-e354. [PMID: 38151174 DOI: 10.1016/j.wneu.2023.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To improve implant stability parameters, including pedicle screw (PS) outer diameter, thread depth, and pitch, by finite element analysis. METHODS Insertion and pullout of the PS were simulated by finite element analysis, and the precision of simulation was evaluated by comparison with mechanical tests. Influences of the parameters on the maximum insertion torque and maximum pullout force were analyzed by computational simulations, including single-factor analysis and orthogonal experiments. RESULTS The simulation results agreed with the mechanical test results. The order of parameters influencing insertion torque and pullout force was outer diameter > pitch > thread depth. When the pilot hole diameter is 0.1 mm larger than the inner diameter of the PS, the calculated Pearson correlation coefficient between the maximum insertion torque and maximum pullout force was r = 0.99. The optimized PS had a maximum insertion torque of 485.16 N·mm and a maximum pullout force of 1726.33 N, 23.9% and 9.1% higher, respectively, than the values of standard screws. CONCLUSIONS The presently used models are feasible for evaluating the implant stability of PSs. The maximum insertion torque and maximum pullout force of PSs are highly correlated and can be improved by increasing the outer diameter and decreasing pitch. Although with the parameters of the PS, pedicle size and bone mineral density are 2 additional factors to consider for better implant stability.
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Affiliation(s)
- Qiang Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China; Shanghai Engineering Research Center of High-Performance Medical Device Materials, Shanghai, People's Republic of China.
| | - Hu Zhao
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Jinshuai Yang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Shihong Song
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xuyan Liu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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Martin L, Jain P, Ferguson Z, Gholamalizadeh T, Moshfeghifar F, Erleben K, Panozzo D, Abramowitch S, Schneider T. A systematic comparison between FEBio and PolyFEM for biomechanical systems. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107938. [PMID: 38056313 PMCID: PMC10843651 DOI: 10.1016/j.cmpb.2023.107938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Finite element simulations are widely employed as a non-invasive and cost-effective approach for predicting outcomes in biomechanical simulations. However, traditional finite element software, primarily designed for engineering materials, often encountered limitations in contact detection and enforcement, leading to simulation failure when dealing with complex biomechanical configurations. Currently, a lot of model tuning is required to get physically accurate finite element simulations without failures. This adds significant human interaction to each iteration of a biomechanical model. This study addressed these issues by introducing PolyFEM, a novel finite element solver that guarantees inversion- and intersection-free solutions with completely automatic collision detection. The objective of this research is to validate PolyFEM's capabilities by comparing its results with those obtained from a well-established finite element solver, FEBio. METHODS To achieve this goal, five comparison scenarios were formulated to assess and validate PolyFEM's performance. The simulations were reproduced using both PolyFEM and FEBio, and the final results were compared. The five comparison scenarios included: (1) reproducing simulations from the FEBio test suite, consisting of static, dynamic, and contact-driven simulations; (2) replicating simulations from the verification paper published alongside the original release of FEBio; (3) a biomechanically based contact problem; (4) creating a custom simulation involving high-energy collisions between soft materials to highlight the difference in collision methods between the two solvers; and (5) performing biomechanical simulations of biting and quasi-stance. RESULTS We found that PolyFEM was capable of replicating all simulations previously conducted in FEBio. Particularly noteworthy is PolyFEM's superiority in high-energy contact simulations, where FEBio fell short, unable to complete over half of the simulations in Scenario 4. Although some of the simulations required significantly more simulation time in PolyFEM compared to FEBio, it is important to highlight that PolyFEM achieved these results without the need for any additional model tuning or contact declaration. DISCUSSION Despite being in the early stages of development, PolyFEM currently provides verified solutions for hyperelastic materials that are consistent with FEBio, both in previously published workflows and novel finite element scenarios. PolyFEM exhibited the ability to tackle challenging biomechanical problems where other solvers fell short, thus offering the potential to enhance the accuracy and realism of future finite element analyses.
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Affiliation(s)
- Liam Martin
- University of Pittsburgh Swanson School of Engineering, USA
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Wang K, Wang X, Li Z, Xie T, Wang L, Luo C, Huang S, Zeng J. The Influence of Screw Positioning on Cage Subsidence in Patients with Oblique Lumbar Interbody Fusion Combined with Anterolateral Fixation. Orthop Surg 2023; 15:3263-3271. [PMID: 37771126 PMCID: PMC10694007 DOI: 10.1111/os.13882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Cage subsidence (CS) has been reported to be one of the most common complications following oblique lumbar interbody fusion (OLIF). To reduce the incidence of CS and improve intervertebral fusion rates, anterolateral fixation (AF) has been gradually proposed. However, the incidence of CS in patients with oblique lumbar interbody fusion combined with anterolateral fixation (OLIF-AF) is still controversial. Additionally, there is a lack of consensus regarding the optimal placement of screws for OLIF-AF, and the impact of screw placement on the incidence of CS has yet to be thoroughly investigated and validated. The objective of this investigation was to examine the correlation between screw placements and CS and to establish an optimized approach for implantation in OLIF-AF. METHODS A retrospective cohort study was undertaken. From October 2017 to December 2020, a total of 103 patients who received L4/5 OLIF-AF for lumbar spinal stenosis or spondylolisthesis or degenerative instability in our department were followed up for more than 12 months. Demographic and radiographic data of these patients were collected. Additionally, screw placement related parameters, including trajectory and position, were measured by anterior-posterior X-ray and axial CT. Analysis was done by chi-square, independent t-test, univariable and multivariable binary logistic regression to explore the correlation between screw placements and CS. Finally, the receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of screw placement-related parameters. RESULTS A total of 103 patients were included, and CS was found in 28 (27.18%) patients. Univariable analysis was firstly performed for each parameter. Next, variables with p-value of <0.05, including bone mineral density (BMD), concave morphology, and screw placement-related parameters were included in the multivariate logistic regression analysis. Significant predictor factors for subsidence were coronal plane angle (CPA) (OR 0.580 ± 0.208, 95% CI 1.187-2.684), implantation point (IP) (L4) (OR 5.732 ± 2.737, 95% CI 1.445-12.166), and IP (L5) (OR 7.160 ± 3.480, 95% CI 1.405-28.683). Furthermore, ROC curves showed that the predictive accuracy of CS was 88.1% for CPA, 77.6% for IP (L4) and 80.9% for IP (L5). CONCLUSIONS We demonstrate that the trajectory of vertebral screws, including angle and position, was closely related to CS. Inserting screws parallel to each other and as close to the endplate as possible while keeping the cage inside the range of the superior and inferior screws are an optimal implantation strategy for OLIF-AF.
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Affiliation(s)
- Kai Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xiandi Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Zhuhai Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Department of Spine SurgeryThe People's Hospital of Guangxi Zhuang Autonomous RegionNanningChina
| | - Tianhang Xie
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Lihang Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Department of Spine SurgeryGuizhou Provincial Orthopedics HospitalGuiyangChina
| | - Chuan Luo
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- School of Mechanical EngineeringSichuan UniversityChengduChina
| | - Shishu Huang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Jiancheng Zeng
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Zhang K, Xu H, Du L, Liu Y, Xu B. Application of self-anchored lateral lumbar interbody fusion in lumbar degenerative diseases. BMC Musculoskelet Disord 2023; 24:836. [PMID: 37872610 PMCID: PMC10594783 DOI: 10.1186/s12891-023-06974-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE The aim of the study was to evaluate the efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF) in lumbar degenerative diseases. METHODS Forty-eight patients with lumbar degenerative disease between January 2019 and June 2020 were enrolled in this study. All patients complained of low back and leg pain, which were aggravated during standing activities and alleviated or disappeared during lying. After general anesthesia, the patient was placed in the right decubitus position. The anterior edge of the psoas major muscle was exposed through an oblique incision of approximately 6 cm, using an extraperitoneal approach. The psoas major muscle was then properly retracted dorsally to expose the disc. After discectomy, a suitable cage filled with autogenous bone graft from the ilium was implanted. Two anchoring plates were inserted separately into the caudal and cranial vertebral bodies to lock the cage. Clinical efficacy was evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI). Lumbar lordosis, intervertebral disc height, spondylolisthesis rate, cage subsidence and fusion rate were also recorded. RESULTS A total of 48 patients were enrolled in this study, including 20 males and 28 females, aged 61.4 ± 7.3 (range 49-78) years old. Surgery was successfully performed in all patients. Lumbar stenosis and instability were observed in 22 cases, disc degenerative disease in eight cases, degenerative spondylolisthesis in nine cases, degenerative scoliosis in six cases, and postoperative revision in three cases. In addition, five patients were diagnosed with osteoporosis. The index levels included L2-3 in three patients, L3-4 in 13 patients, L4-5 in 23 patients, L2-4 in three patients, and L3-5 in six patients. The operation time was 81.1 ± 6.4 (range 65-102) min. Intraoperative blood loss was 39.9 ± 8.5 (range 15-72) mL. No severe complications occurred, such as nerve or blood vessel injuries. The patients were followed up for 11.7 ± 2.3 (range 4-18) months. At the last follow-up, the VAS decreased from 6.2 ± 2.3 to 1.7 ± 1.1, and the ODI decreased from 48.4% ± 11.2% to 10.9% ± 5.5%. Radiography showed satisfactory postoperative spine alignment. No cage displacement was found, but cage subsidence 2-3 mm was found in five patients without obvious symptoms, except transient low back pain in an obese patient. The lumbar lordosis recovered from 36.8° ± 7.9° to 47.7° ± 6.8°, and intervertebral disc height recovered from 8.2 ± 2.0 mm to 11.4 ± 2.5 mm. The spondylolisthesis rate decreased from 19.9% ± 4.9% to 9.4% ± 3.2%. The difference between preoperative and last follow-up was statistically significant (P<0.05). CONCLUSION SA-LLIF can provide immediate stability and good results for lumbar degenerative diseases with a standalone anchored cage without posterior internal fixation.
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Affiliation(s)
- Kaihui Zhang
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Haiwei Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Lilong Du
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Yue Liu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Baoshan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, 406 JieFangNan Road, Hexi District, Tianjin, 300211, People's Republic of China.
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CreveCoeur TS, Sperring CP, DiGiorgio AM, Chou D, Chan AK. Antepsoas Approaches to the Lumbar Spine. Neurosurg Clin N Am 2023; 34:619-632. [PMID: 37718108 DOI: 10.1016/j.nec.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Lumbar interbody fusion (LIF) is a well-established approach in treating spinal deformity and degenerative conditions of the spine. Since its inception in the 20th century, LIF has continued to evolve, allowing for minimally invasive approaches, high fusion rates, and improving disability scores with favorable complication rates. The anterior to the psoas (ATP) approach utilizes a retroperitoneal pathway medial to the psoas muscle to access the L1-S1intervertebral disc spaces. In contrast to the transpsoas arppoach, its primary advantage is avoiding transgressing the psoas muscle and the contained lumbar plexus, which potentially decreases the risk of injury to the lumbar plexus. Avoiding transgression of the psoas may minimize the risk of transient or permanent neurological deficits secondary to lumbar plexus injury. Indications for ATP approaches may expand as it is shown to be a safe and effective method of achieving spinal arthrodesis.
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Affiliation(s)
- Travis S CreveCoeur
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10033, USA
| | - Colin P Sperring
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 710 West 168th Street, New York, NY 10033, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Dean Chou
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY 10034, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University College of Physicians and Surgeons, 5141 Broadway, 3FW, Room 20, New York, NY 10034, USA.
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Hao J, Tang X, Jiang N, Wang H, Jiang J. Biomechanical stability of oblique lateral interbody fusion combined with four types of internal fixations: finite element analysis. Front Bioeng Biotechnol 2023; 11:1260693. [PMID: 37818236 PMCID: PMC10561304 DOI: 10.3389/fbioe.2023.1260693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
Objective: Using finite element analysis to identify the optimal internal fixation method for oblique lateral lumbar interbody fusion (OLIF), providing guidance for clinical practice. Methods: A finite element model of the L4 - L5 segment was created. Five types of internal fixations were simulated in the generated L4-L5 finite element (FE) model. Then, six loading scenarios, i.e., flexion, extension, left-leaning, right-leaning, rotate left, and rotate right, were simulated in the FE models with different types of fixations. The biomechanical stability of the spinal segment after different fixations was investigated. Results: Regarding the range of motion (ROM) of the fused segment, OLIF + Bilateral Pedicle Screws (BPS) has a maximum ROM of 1.82° during backward bending and the smallest ROM in all directions of motion compared with other models. In terms of the von Mises stress distribution on the cage, the average stress on every motion direction of OLIF + BPS is about 17.08MPa, and of OLIF + Unilateral Vertebral Screw - Pedicle Screw (UVS-PS) is about 19.29 MPa. As for the von Mises stress distribution on the internal fixation, OLIF + BPS has the maximum internal fixator stress in left rotation (31.85 MPa) and OLIF + Unilateral Pedicle Screw (UPS) has the maximum internal fixator stress in posterior extension (76.59 MPa). The data of these two models were smaller than those of other models. Conclusion: OLIF + BPS provides the greatest biomechanical stability, OLIF + UPS has adequate biomechanical stability, OLIF + UVS-PS is inferior to OLIF + UPS synthetically, and OLIF + Double row vertical screw (DRVS) and Individual OLIF (IO) do not present significant obvious advantages.
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Affiliation(s)
- Jiayu Hao
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - XianSheng Tang
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Nizhou Jiang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - Hong Wang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
| | - Jian Jiang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian University of Technology, Dalian, China
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Yu Y, Wang Y, Xie Y, Feng C, Chen Y, Xu J, Fan X. Comparison of the mid-term clinical efficacy of different fixtaion methods combined with oblique lumbar interbody fusion in treating lumbar degenerative diseases. J Orthop Surg (Hong Kong) 2023; 31:10225536231209552. [PMID: 37859589 DOI: 10.1177/10225536231209552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To compare the mid-term follow-up clinical efficacy among three treatment approaches for lumbar degenerative diseases (LDD): standalone oblique lumbar interbody fusion (SF), oblique lumbar interbody fusion combined with lateral screw fixation (LF), and oblique lumbar interbody fusion combined with posterior screw fixation (PF). METHOD This retrospective study included a total of 71 cases of single level LDD that underwent OLIF in Hospital of Chengdu University of Traditional Chinese Medicine were retrospectively collected between March 2016 and September 2017. Patients were divided into three groups: 24 cases in the SF group, 24 cases in the LF group and 23 cases in the PF group. Various parameters, such as operation time, hospitalization time, and complications, were recorded. The fusion condition was assessed at last follow up. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) from pre-operation to 5 years post-surgery. RESULTS Significantly lower mean operation time and hospitalization time were observed in the SF and LF groups compared to the PF group (p < .05). However, no significant difference in fusion rate was found among the three groups. Regarding clinical outcomes, there was no statistically significant difference in VAS scores between the three groups during all follow-up periods. At the 6th month and 1st year after surgery, the SF and LF groups had significantly lower Oswestry Disability Index (ODI) scores compared to the PF group (p < .05). There was no significant difference in perioperative complication rates among the three groups (p > .05). In the LF group, one case of instrument displacement and urethra injury were reported, while in the SF, LF, and PF groups, 10, 9, and 3 cases of cage subsidence were reported, respectively. CONCLUSION The study findings suggest that oblique lumbar interbody fusion (OLIF) is a safe and effective treatment for mid-term management of lumbar degenerative diseases (LDD). Compared to the posterior screw fixation (PF) group, both the standalone OLIF (SF) and OLIF combined with lateral screw fixation (LF) groups showed advantages in terms of reduced operation time, shorter hospitalization, and faster symptom alleviation in the short-term. However, OLIF combined with PF demonstrated comparable symptom relief in the mid-term and had the additional benefit of lower cage subsidence rates while improving fusion rates as well.
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Affiliation(s)
- Yang Yu
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yongtao Wang
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yizhou Xie
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengzhi Feng
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuzhou Chen
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiajia Xu
- Master of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaohong Fan
- Doctor of Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Miscusi M, Trungu S, Ricciardi L, Forcato S, Piazza A, Ramieri A, Raco A. Stand-Alone Oblique Lumbar Interbody Fusion (OLIF) for the Treatment of Adjacent Segment Disease (ASD) after Previous Posterior Lumbar Fusion: Clinical and Radiological Outcomes and Comparison with Posterior Revision Surgery. J Clin Med 2023; 12:jcm12082985. [PMID: 37109321 PMCID: PMC10144531 DOI: 10.3390/jcm12082985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Radiological evidence of adjacent segment disease (ASD) has been reported to have a prevalence of more than 30% and several risk factors have been reported. The aim of this study is to evaluate the clinical and radiological outcomes of patients with symptomatic ASD treated with stand-alone OLIF and compare results with a posterior revision surgery cohort. Methods: This is a retrospective case-control study. Clinical-patient-reported outcomes were obtained at preoperative, postoperative and final follow-up visits using the Short Form (SF-36) scale, the Oswestry Disability Index (ODI) and the visual analog scale (VAS). Radiological measures include lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental coronal Cobb angle and intervertebral disc height (DH). The data are compared with a retrospective series of patients that underwent a posterior revision surgery for ASD. Results: Twenty-eight patients in the OLIF group and 25 patients in the posterior group meet inclusion criteria. The mean ages at the time of the surgery are 65.1 years and 67.5, respectively. The mean follow-up time is 36.1 months (range of 14-56). The clinical outcomes significantly improve from preoperative values from the surgery in both groups. The radiological parameters are significantly improved postoperatively and were maintained at the last follow-up in both groups. A statistically significant difference is observed between the two groups for minor complication rate, length of surgery, blood loss and DH restoration. Conclusions: Stand-alone OLIF is an effective and safe technique with low morbidity and complication rates for the treatment of selected patients with symptomatic ASD following a previous lumbar fusion.
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Affiliation(s)
- Massimo Miscusi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Sokol Trungu
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Luca Ricciardi
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Forcato
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Amedeo Piazza
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Ramieri
- Department of Orthopedics, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonino Raco
- NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
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Lefèvre E, Szadkowski M, Fière V, Vieira TD, Ould-Slimane M, d'Astorg H. Implications of cage impactions in single-level OLIF treatment of degenerative spondylolisthesis. Orthop Traumatol Surg Res 2023; 109:103385. [PMID: 35933020 DOI: 10.1016/j.otsr.2022.103385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/03/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact. OBJECTIVES To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis. METHOD A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoperative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiography during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at≥1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS). RESULTS In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n=33) of cases and of these, 94% (n=32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P=0.034). The "CI" group had a 9.5% lower ODI score than the "non-CI" group (P=0.0040), but both provided excellent ODI gains of 30.8±16 and 32.9±15.5% (P<0.0001). An "anterior" position of the implant allowed a greater gain in lumbar lordosis (P<0.001) but was associated with greater CI occurrence (P<0.001), with an OR of 6.75 (P=0.0018). CONCLUSION The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an "anterior" implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up. LEVEL OF EVIDENCE IV, non-comparative cohort study.
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Affiliation(s)
- Emeric Lefèvre
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Marc Szadkowski
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Vincent Fière
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
| | | | - Henri d'Astorg
- Centre orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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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: 4] [Impact Index Per Article: 4.0] [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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Xue S, Wu T. Biomechanical Performances of an Oblique Lateral Interbody Fusion Cage in Models with Different Bone Densities: A Finite Element Analysis. Indian J Orthop 2023; 57:86-95. [PMID: 36660489 PMCID: PMC9789258 DOI: 10.1007/s43465-022-00775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Study Design Finite element models of the L3-S1 vertebrae were reconstructed using computed tomography scans. Objective We compared the biomechanical performances of an oblique lateral interbody fusion (OLIF) cage in different bone density mode. Summary of Background Data Low bone density is an els.key factor limiting the use of stand-alone OLIF cage. Methods Four models-intact (M0), normal bone density with OLIF (M1), bone mass loss with OLIF (M2), and osteoporotic with OLIF (M3)-were created based on 3-dimensional scans. Flexion, extension, and lateral bending movements (each lasting 10 N·m) were performed on the superior surface of the L3 vertebra with a compressive preload of 500 N. Range of motion (ROM), peak stresses in the L4-5 cortical endplates, cage stress, and adjacent intervertebral disk stress were evaluated. Results ROMs during different physiological movements were similar to those reported by previous researchers. Compared with that in M0, L4-5 ROMs of all movements decreased in M1, M2 and M3, most evidently in M3. Stress distribution in the cortical endplates rose to 7.8% in M1 and M2, even 16.2% in M3. Cage stress increased by less than 8.1% in M1 and M2, but by 25.3% in M3, especially in the movements of extension and right rotation. Compared with that in M0, L3-4 and L5-S1 intervertebral disk stress increased with bone density in all the other models, by up to 69.8% and 98.3%, respectively. As osteoporosis worsened, stress in the adjacent intervertebral disk also increased. Conclusion Stand-alone OLIF in M3 is not recommended because of the risk of cage subsidence. OLIF in M1 and M2 achieved similar results in various lumbar spine movements. In M1 and M2 model (T > - 2.5), the L4-L5 showed reduced mobility in all directions, increased rigidity, limited cage displacement, lessened deformation, and better stability.
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Affiliation(s)
- Shuangtao Xue
- Darpartment of Orthopaedics, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, 241001 Anhui China
| | - Tianliang Wu
- Darpartment of Orthopaedics, The Second People’s Hospital of Wuhu, Wuhu Hospital Affiliated to East China Normal University, Wuhu, 241001 Anhui China
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Wang R, Wu Z. Recent advancement in finite element analysis of spinal interbody cages: A review. Front Bioeng Biotechnol 2023; 11:1041973. [PMID: 37034256 PMCID: PMC10076720 DOI: 10.3389/fbioe.2023.1041973] [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: 09/12/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Finite element analysis (FEA) is a widely used tool in a variety of industries and research endeavors. With its application to spine biomechanics, FEA has contributed to a better understanding of the spine, its components, and its behavior in physiological and pathological conditions, as well as assisting in the design and application of spinal instrumentation, particularly spinal interbody cages (ICs). IC is a highly effective instrumentation for achieving spinal fusion that has been used to treat a variety of spinal disorders, including degenerative disc disease, trauma, tumor reconstruction, and scoliosis. The application of FEA lets new designs be thoroughly "tested" before a cage is even manufactured, allowing bio-mechanical responses and spinal fusion processes that cannot easily be experimented upon in vivo to be examined and "diagnosis" to be performed, which is an important addition to clinical and in vitro experimental studies. This paper reviews the recent progress of FEA in spinal ICs over the last six years. It demonstrates how modeling can aid in evaluating the biomechanical response of cage materials, cage design, and fixation devices, understanding bone formation mechanisms, comparing the benefits of various fusion techniques, and investigating the impact of pathological structures. It also summarizes the various limitations brought about by modeling simplification and looks forward to the significant advancement of spine FEA research as computing efficiency and software capabilities increase. In conclusion, in such a fast-paced field, the FEA is critical for spinal IC studies. It helps in quantitatively and visually demonstrating the cage characteristics after implanting, lowering surgeons' learning costs for new cage products, and probably assisting them in determining the best IC for patients.
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Affiliation(s)
- Ruofan Wang
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zenghui Wu
- Guangzhou Key Laboratory of Spine Disease Prevention and Treatment, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Zenghui Wu,
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Deng C, Feng H, Ma X, Chen C, Mei J, Sun L. Comparing oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar disc herniation complicated with lumbar instability. BMC Musculoskelet Disord 2022; 23:1104. [PMID: 36529717 PMCID: PMC9761955 DOI: 10.1186/s12891-022-06075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the early clinical effect of oblique lumbar interbody fusion with lateral screw fixation and percutaneous endoscopic transforaminal discectomy (OLIF-PETD) in the treatment of lumbar disc herniation with lumbar instability. METHODS A total of 22 patients with lumbar disc herniation and lumbar instability from August 2017 to August 2019 were enrolled in this retrospective study. The general information, perioperative indicators and complications were recorded. The clinical outcomes and radiological outcomes were evaluated before the operation, seven days after the operation, and at the last follow-up. Vertebral fusion and degree of multifidus muscle injury were evaluated at the last follow-up. RESULTS In this study, OLIF + PETD showed shorter incision length compared to the MIS-TLIF (P < 0.001). In the two groups, the clinical outcomes and radiological outcomes were significantly improved compared with the preoperative (P < 0.001). At the seven days after the operation and the last follow-up, the VAS of OLIF + PETD group was lower than that of MIS-TLIF group (P < 0.05). OLIF + PETD could give superior outcome in restoring disc height (P < 0.001), but the fusion segment angle of OLIF + PETD group was larger compared to the MIS-TLIF group seven days after the operation and at the last follow-up (P < 0.05). In addition, the fusion rate was not significantly different between the two groups (P > 0.05), but OLIF + PETD could avoid the multifidus injury (P < 0.001). CONCLUSION Compared to MIS-TLIF, OLIF-PETD can achieve satisfactory decompression effects and fusion rates with less multifidus injury and postoperative low back pain, which may be an alternative choice for the treatment of lumbar disc herniation combined with lumbar instability.
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Affiliation(s)
- Chen Deng
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China
| | - Haoyu Feng
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xun Ma
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Chen Chen
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Jun Mei
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Lin Sun
- grid.470966.aDepartment of Orthopedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 030032 Taiyuan, China ,grid.412793.a0000 0004 1799 5032Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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Nan C, Ma Z, Liu Y, Ma L, Li J, Zhang W. Impact of cage position on biomechanical performance of stand-alone lateral lumbar interbody fusion: a finite element analysis. BMC Musculoskelet Disord 2022; 23:920. [PMID: 36258213 PMCID: PMC9578219 DOI: 10.1186/s12891-022-05873-x] [Citation(s) in RCA: 2] [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: 04/11/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to compare the biomechanical performance of various cage positions in stand-alone lateral lumbar interbody fusion(SA LLIF). Methods An intact finite element model of the L3-L5 was reconstructed. The model was verified and analyzed. Through changing the position of the cage, SA LLIF was established in four directions: anterior placement(AP), middle placement(MP), posterior placement(PP), oblique placement(OP). A 400 N vertical axial pre-load was imposed on the superior surface of L3 and a 10 N/m moment was applied on the L3 superior surface along the radial direction to simulate movements of flexion, extension, lateral bending, and axial rotation. Various biomechanical parameters were evaluated for intact and implanted models in all loading conditions, including the range of motion (ROM) and maximum stress. Results In the SA LLIF models, the ROM of L4-5 was reduced by 84.21–89.03% in flexion, 72.64–82.26% in extension, 92.5-95.85% in right and left lateral bending, and 87.22–92.77% in right and left axial rotation, respectively. Meanwhile, ROM of L3-4 was mildly increased by an average of 9.6% in all motion directions. Almost all stress peaks were increased after SA LLIF, including adjacent disc, facet joints, and endplates. MP had lower stress peaks of cage and endplates in most motion modes. In terms of the stress on facet joints and disc of the cephalad segment, MP had the smallest increment. Conclusion In our study, SA LLIF risked accelerating the adjacent segment degeneration. The cage position had an influence on the distribution of endplate stress and the magnitude of facet joint stress. Compared with other positions, MP had the slightest effect on the stress in the adjacent facet joints. Meanwhile, MP seems to play an important role in reducing the risk of cage subsidence.
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Affiliation(s)
- Chong Nan
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Zhanbei Ma
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Yuxiu Liu
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Liang Ma
- Department of Orthopedic, Central Hospital, Baoding No. 1, 071000, Baoding, Hebei Province, China
| | - Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 050000, Shijiazhuang, Hebei Province, China.
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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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Kim H, Chang BS, Chang SY. Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review. Neurospine 2022; 19:163-176. [PMID: 35378589 PMCID: PMC8987540 DOI: 10.14245/ns.2143236.618] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure.
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Affiliation(s)
- Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Sam Yeol Chang https://orcid.org/0000-0003-4152-687X Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 03080, Korea
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Qin Y, Zhao B, Yuan J, Xu C, Su J, Hao J, Lv J, Wang Y. Does cage position affect the risk of cage subsidence after oblique lumbar interbody fusion in the osteoporotic lumbar spine: a finite element analysis. World Neurosurg 2022; 161:e220-e228. [PMID: 35123023 DOI: 10.1016/j.wneu.2022.01.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after OLIF. METHODS A finite element (FE) model of an intact L3-L5 lumbar spine was constructed. After validation, an osteoporosis model (OP) was constructed by assigning osteoporotic material properties. SA models (SA1, SA2, SA3) and BPSF models (BPSF1, BPSF2, BPSF3) in which a cage was placed in the anterior, middle and posterior third of the L5 superior endplate (SEP) were constructed at the L4-L5 segment of the OP. The L4-L5 range of motion (ROM), the stress of the L5 SEP, the stress of the cage and the stress of fixation were compared among the different models. RESULTS According to the degree of ROM of L4-L5, the stress of the L5 SEP and the stress of the cage for most physiological motions, the SA and BPSF models were ranked as follows: SA2<SA1<SA3, BPSF2<BPSF1<BPSF3. In BPSF2, the stress of fixation was minimal in most motions. At the same cage position, the ROM of L4-L5, the stress of the L5 SEP and the stress of the cage in the BPSF models were significantly reduced compared with those in SA models; compared with SA2, BPSF2 had a maximum reduction of 83.24%, 70.71% and 73.52% in these parameters, respectively.results CONCLUSIONS: Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.
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Affiliation(s)
- Yichuan Qin
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Bin Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jie Yuan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Chaojian Xu
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Junqiang Su
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jiaqi Hao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Jie Lv
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China
| | - Yongfeng Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi 030001, China.
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Treatment of one-level degenerative lumbar spondylolisthesis with severe stenosis by oblique lateral interbody fusion: Clinical and radiological results after a minimal 1-year follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Biomechanical Evaluation of Stand-Alone Oblique Lateral Lumbar Interbody Fusion Under 3 Different Bone Mineral Density Conditions: A Finite Element Analysis. World Neurosurg 2021; 155:e285-e293. [PMID: 34418606 DOI: 10.1016/j.wneu.2021.08.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the biomechanical stability of stand-alone (SA) oblique lateral interbody fusion (OLIF) under different bone mineral density conditions. METHODS The finite element model of L2-L5 was reconstructed and verified via computed tomography scan images (M0). The L4-L5 segment of SA OLIF was created based on the validation model. By changing bone mineral density, SA OLIF was established in the normal bone mineral density group (M1), osteopenia group (M2), and osteoporosis group (M3). A 500 N vertical axial preload was imposed on the superior surface of L2, and a 10 N-m moment was applied on the L2 superior surface along the radial direction to simulate 6 different physiological motions: flexion, extension, left and right lateral bending, left and right rotation. RESULTS Compared with M0, the range of motion of the fusion segment was significantly reduced, and the maximum stress of the upper and lower end plates was significantly increased in all motion modes. Compared with M1, the maximum relative increases of range of motion, cephalic end-plate stress and tail end-plate stress of M2 in the L4-L5 segment were 39.1%, 9.9%, and 10.7%, and the maximum increases of the above parameters in M3 were 100%, 28.9%, and 31.6%. The maximum stress of the tail end plate of the M3 model during flexion was 54.617 MPa, which was very close to the yield stress of the lamellar bone (60 MPa). CONCLUSIONS With the increase of the degree of osteoporosis, the maximum stress on the upper and lower end plates of the fusion segment increased significantly, thus increasing the potential risk of implant subsidence. SA OLIF could not provide sufficient stability for patients with osteoporosis.
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Tartara F, Cofano F, Di Perna G, Tancioni F, Garbossa D. Letter to the Editor Regarding: "Biomechanical Comparison of Stand-Alone and Bilateral Pedicle Screw Fixation for Oblique Lumbar Interbody Fusion Surgery-A Finite Element Analysis". World Neurosurg 2021; 150:248-249. [PMID: 34098655 DOI: 10.1016/j.wneu.2021.03.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo, Turin, Italy; Neurosurgery Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Neurosurgery Unit, Department of Neuroscience, University of Turin, Turin, Italy.
| | | | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, University of Turin, Turin, Italy
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Fang G, Sang H. In Reply to the Letter to the Editor Regarding "Biomechanical Comparison of Stand-Alone and Bilateral Pedicle Screw Fixation for Oblique Lumbar Interbody Fusion Surgery-A Finite Element Analysis". World Neurosurg 2021; 150:250. [PMID: 34098656 DOI: 10.1016/j.wneu.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Guofang Fang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, People's Republic of China
| | - Hongxun Sang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, People's Republic of China.
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Cai K, Luo K, Zhu J, Zhang K, Yu S, Ye Y, Jiang G. Effect of pedicle-screw rod fixation on oblique lumbar interbody fusion in patients with osteoporosis: a retrospective cohort study. J Orthop Surg Res 2021; 16:429. [PMID: 34217340 PMCID: PMC8254285 DOI: 10.1186/s13018-021-02570-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To investigate the radiological and clinical outcomes of patients with or without pedicle-screw rod fixation (PSRF) in OLIF surgery. METHODS Between June 2017 and December 2019, 66 consecutive patients who underwent OLIF surgery at two centers were divided into stand-alone and combined groups according to whether or not PSRF was used. Imaging and clinical data were collected preoperatively, postoperatively, 3 and 6 months postoperatively, and at the last follow-up. Related coefficient and multiple linear regression analysis was used to detect the influencing factors of cage subsidence (CS). RESULTS There was a lower baseline BMD in the combined group (p = 0.005). The combined group showed superior VAS score at 3 months postoperatively, although there was no difference in long-term VAS and ODI scores between the two groups. The foraminal height (FH) of the two groups was comparable at preoperatively, postoperatively, and 3 months postoperatively, but the combined group showed better maintenance of FH at 6 months postoperatively (p = 0.049) and last follow-up (p = 0.019). The total CS (tCS) of the combined group was lower than that of the stand-alone group during the whole follow-up period (all p ≤ 0.001). Multiple linear regression suggested that lower BMD was the risk factor for main CS, and PSRF could significantly reduce the BMD threshold for severe CS (-4.77 vs -1.38). CONCLUSIONS OLIF combined with PSRF can effectively avoid foraminal height loss and prevent severe CS, which may be more suitable for patients with osteoporosis or osteopenia and improve clinical outcomes.
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Affiliation(s)
- Kaiwen Cai
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.,Institute of Orthopaedics, Ningbo University, Ningbo, People's Republic of China
| | - Kefeng Luo
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.,Institute of Orthopaedics, Ningbo University, Ningbo, People's Republic of China
| | - Jinjin Zhu
- Department of Orthopaedic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Kai Zhang
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.,Institute of Orthopaedics, Ningbo University, Ningbo, People's Republic of China
| | - Shengkai Yu
- The Medical School of Ningbo University, Ningbo, People's Republic of China
| | - Yi Ye
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China.,Institute of Orthopaedics, Ningbo University, Ningbo, People's Republic of China
| | - Guoqiang Jiang
- Department of Orthopaedic, The Affiliated Hospital of Medical School of Ningbo University, No. 247, Renmin Road, Jiangbei District, Ningbo, Zhejiang, People's Republic of China. .,Institute of Orthopaedics, Ningbo University, Ningbo, People's Republic of China.
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Fan W, Guo LX, Zhao D. Posterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion: Finite Element Analysis of the Vibration Characteristics of Fused Lumbar Spine. World Neurosurg 2021; 150:e81-e88. [PMID: 33647495 DOI: 10.1016/j.wneu.2021.02.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Previous studies have investigated biomechanical characteristics of the lumbar spine after different types of lumbar interbody fusion surgery under static loadings. However, very few have dealt with the whole-body vibration (WBV) condition that is typically present in vehicles. The aim of this study was to compare the influence of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) on dynamic responses of the fused lumbar spine to vertical WBV. METHODS The PLIF and TLIF procedures with bilateral pedicle screw fixation at L4-L5 level were simulated by modifying a previously validated intact lumbar L1-S1 finite element model. The PLIF and TLIF models were subjected to a sinusoidal vertical load with a compressive follower preload, and computed for transient dynamic analysis. The obtained dynamic responses for the models at the fused and adjacent levels were collected and compared. RESULTS The results showed that the contact force between endplate and cage was higher in the PLIF model than in the TLIF model, indicating that PLIF allowed for higher compressive load across the anterior structure. At fused L4-L5 level, the TLIF led to a higher stress in the endplate and posterior BPSF system than the PLIF. At adjacent L3-L4 level and L5-S1 level, the computed dynamic responses, in terms of stress and deformation, for the PLIF and TLIF models showed very few differences. CONCLUSIONS This study may be helpful to quantify dynamic mechanical properties of the fused lumbar spine, and better understand biomechanical differences between the PLIF and TLIF procedures during vibration.
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Affiliation(s)
- Wei Fan
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China.
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Dan Zhao
- Department of Medicine, Liaoning Special Education Teachers College, Shenyang, China; School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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