Faculty Collaboration Database

A biomechanical investigation of lumbar interbody fusion techniques. J Mech Behav Biomed Mater 2022 Jan;125:104961

Date

11/16/2021

Pubmed ID

34781226

DOI

10.1016/j.jmbbm.2021.104961

Scopus ID

2-s2.0-85118900449 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

The anterior, posterior, transforaminal, and circumferential lumbar interbody fusions (ALIF, PLIF, TLIF, CLIF/360) are used to treat spondylolisthesis, trauma, and degenerative pathologies. This study aims to investigate the biomechanical effects of the lumbar interbody fusion techniques on the spine. A validated T12-sacrum lumbar spine finite-element model was used to simulate surgical fusion of L4-L5 segment using ALIF, PLIF with one and two cages, TLIF with unilateral and bilateral fixation, and CLIF/360. The models were simulated under pure-moment and combined (moment and compression) loadings to investigate the effect of different lumbar interbody fusion techniques on range of motion, forces transferred through the vertebral bodies, disc pressures, and endplate stresses. The range of motion of the lumbar spine was decreased the most for fusions with bilateral posterior instrumentations (TLIF, PLIF, and CLIF/360). The increase in forces transmitted through the vertebrae and increase in disc pressures were directly proportional to the range of motion. The discs superior to fusion were under higher pressure, which was attributed to adjacent segment degeneration in the superior discs. The increase in endplate stresses was directly proportional to the cross-sectional area and was greater in caudal endplates at the fusion level, which was attributed to cage subsidence. The response of the models was in line with overall clinical observations from the patients and can be further used for future studies, which aim to investigate the effect of geometrical and material variations in the spine. The model results will assist surgeons in making informed decisions when selecting fusion procedures based on biomechanical effects.

Author List

Umale S, Yoganandan N, Baisden JL, Choi H, Kurpad SN

Authors

Shekar N. Kurpad MD, PhD Sr Associate Dean, Professor in the Neurosurgery department at Medical College of Wisconsin
Narayan Yoganandan PhD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Lumbar Vertebrae
Spinal Fusion