Biomechanical study of different approach for lumbar interbody fusion surgeries under vibration load_Journal of Biomedical Engineering

Authors：

 FAN Wei , ZHANG Chi , WANG Qingdong , ZHANG Dongxiang , GUO Lixin

School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, P.R.China;

Corresponding?author：

FAN Wei, Email: fanwei@mail.neu.edu.cn

Keywords：

lumbar interbody fusion; biomechanics; bony fusion; finite element; vibration

DOI：

10.7507/1001-5515.202102010

Video：

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The human spine injury and various lumbar spine diseases caused by vibration have attracted extensive attention at home and abroad. To explore the biomechanical characteristics of different approaches for lumbar interbody fusion surgery combined with an interspinous internal fixator, device for intervertebral assisted motion (DIAM), finite element models of anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are created by simulating clinical operation based on a three-dimensional finite element model of normal human whole lumbar spine. The fusion level is at L4–L5, and the DIAM is implanted between spinous process of L4 and L5. Transient dynamic analysis is conducted on the ALIF, TLIF and LLIF models, respectively, to compute and compare their stress responses to an axial cyclic load. The results show that compared with those in ALIF and TILF models, contact forces between endplate and cage are higher in LLIF model, where the von-Mises stress in endplate and DIAM is lower. This implies that the LLIF have a better biomechanical performance under vibration. After bony fusion between vertebrae, the endplate and DIAM stresses for all the three surgical models are decreased. It is expected that this study can provide references for selection of surgical approaches in the fusion surgery and vibration protection for the postsurgical lumbar spine.

Citation： FAN Wei, ZHANG Chi, WANG Qingdong, ZHANG Dongxiang, GUO Lixin. Biomechanical study of different approach for lumbar interbody fusion surgeries under vibration load. Journal of Biomedical Engineering, 2021, 38(5): 877-884. doi: 10.7507/1001-5515.202102010 Copy

1.	Spiker W R, Goz V, Brodke D S. Lumbar interbody fusions for degenerative spondylolisthesis: review of techniques, indications, and outcomes. Global Spine J, 2019, 9(1): 77-84.
2.	韋江波, 宋躍明, 劉立岷, 等. 腰椎椎間融合堅強固定與彈性固定生物力學效果的三維有限元分析. 生物醫學工程學雜志, 2015, 32(2): 316-320.
3.	張振軍, 廖振華, 孫藝萄, 等. 腰椎椎間融合器及其在椎間融合術中的生物力學研究進展. 醫用生物力學, 2018, 33(5): 465-470.
4.	Xu D S, Walker C T, Godzik J, et al. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med, 2018, 6(6): 104.
5.	劉政, 李宏偉, 王海洲, 等. 腰椎融合術式研究進展. 醫學綜述, 2018, 24(11): 2175-2180.
6.	顏文濤, 趙改平, 方新果, 等. 經椎間孔腰椎椎間融合術式模型的生物力學研究. 生物醫學工程學雜志, 2015, 32(1): 67-72.
7.	Sim H B, Murovic J A, Cho B Y, et al. Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segments laboratory investigation. J Neurosurg Spine, 2010, 12(6): 700-708.
8.	Palepu V, Helgeson M D, Molyneaux-Francis M, et al. The effects of bone microstructure on subsidence risk for ALIF, LLIF, PLIF, and TLIF spine cages. J Biomech Eng, 2018, 141(3): 031002.
9.	Fan W, Guo L X. A comparison of the influence of three different lumbar interbody fusion approaches on stress in the pedicle screw fixation system: finite element static and vibration analyses. Int J Numer Method Biomed Eng, 2019, 35(3): e3162.
10.	張振軍, 李文釗, 李慧, 等. 多孔鈦腰椎融合器在不同入路椎間融合術中的生物力學性能. 醫用生物力學, 2019, 34(3): 243-250.
11.	Wilder D G, Pope M H. Epidemiological and aetiological aspects of low back pain in vibration environments. Clin Biomech, 1996, 11(2): 61-73.
12.	Fan W, Guo L X. Prediction of the influence of vertical whole-body vibration on biomechanics of spinal segments after lumbar interbody fusion surgery. Clin Biomech, 2021, 86: 105389.
13.	Rohlmann A, Hinz B, Blüthner R, et al. Loads on a spinal implant measured in vivo during whole-body vibration. Eur Spine J, 2010, 19(7): 1129-1135.
14.	吳楠, 裴葆青, 王唯, 等. 后路椎間融合術后全腰椎模態分析. 醫用生物力學, 2018, 33(4): 320-325.
15.	Xu M, Yang J, Lieberman I, et al. The effect of surgical alignment in adult scoliotic spines on axial cyclic vibration: a finite element study. J Comput Inf Sci Eng, 2019, 19(2): 021006.
16.	Fan W, Guo L X. The effect of non-fusion dynamic stabilization on biomechanical responses of the implanted lumbar spine during whole-body vibration. Comput Methods Programs Biomed, 2020, 192: 105441.
17.	Guo L X, Fan W. Dynamic response of the lumbar spine to whole-body vibration under a compressive follower preload. Spine, 2018, 43(3): E143-E153.
18.	Peck J H, Kavlock K D, Showalter B L, et al. Mechanical performance of lumbar intervertebral body fusion devices: an analysis of data submitted to the Food and Drug Administration. J Biomech, 2018, 78(3): 87-93.
19.	Más Y, Gracia L, Ibarz E, et al. Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations. PLoS One, 2017, 12(11): e0188328.
20.	Lo H J, Chen C S, Chen H M, et al. Application of an interspinous process device after minimally invasive lumbar decompression could lead to stress redistribution at the pars interarticularis: a finite element analysis. BMC Musculoskelet Disord, 2019, 20(1): 213.
21.	馬亮, 許永濤, 佘遠舉. 腰椎融合聯合上一節段棘突間動態固定的有限元分析. 中國組織工程研究, 2018, 22(23): 3647-3653.
22.	Agarwal A, Palepu V, Agarwal A K, et al. Biomechanical evaluation of an endplate-conformed polycaprolactone-hydroxyapatite intervertebral fusion graft and its comparison with a typical nonconformed cortical graft. J Biomech Eng, 2013, 135(6): 61005-61009.
23.	Li J, Wang W K, Zuo R, et al. Biomechanical stability before and after graft fusion with unilateral and bilateral pedicle screw fixation: finite element study. World Neurosurg, 2019, 123: e228-e234.
24.	Shen H K, Chen Y R, Liao Z H, et al. Biomechanical evaluation of anterior lumbar interbody fusion with various fixation options: finite element analysis of static and vibration conditions. Clin Biomech, 2021, 84: 105339.
25.	項嬪, 都承斐, 莫中軍, 等. 不同振動載荷刺激對 L1-L5 腰椎的生物力學響應研究. 生物醫學工程學雜志, 2015, 32(1): 48-54.
26.	Xu M, Yang J, Lieberman I, et al. Finite element method-based study for effect of adult degenerative scoliosis on the spinal vibration characteristics. Comput Biol Med, 2017, 84: 53-58.
27.	Guo L X, Fan W. The effect of single-level disc degeneration on dynamic response of the whole lumbar spine to vertical vibration. World Neurosurg, 2017, 105: 510-518.
28.	Fan Ruoxun, Liu Jie, Liu Jun. Finite element investigation on the dynamic mechanical properties of low-frequency vibrations on human L2-L3 spinal motion segments with different degrees of degeneration. Med Biol Eng Comput, 2020, 58(12): 3003-3016.
29.	Kim H J, Bak K H, Chun H J, et al. Posterior interspinous fusion device for one-level fusion in degenerative lumbar spine disease: comparison with pedicle screw fixation - preliminary report of at least one year follow up. J Korean Neurosurg Soc, 2012, 52(4): 359-364.
30.	Spicher A, Schmoelz W, Schmid R, et al. Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures. Biomed Tech (Berl), 2020, 65(2): 183-189.
31.	Lo C C, Tsai K J, Zhong Z C, et al. Biomechanical differences of Coflex-F and pedicle screw fixation combined with TLIF or ALIF-a finite element study. Comput Methods Biomech Biomed Engin, 2011, 14(11): 947-956.
32.	Chiang M F, Zhong Z C, Chen C S, et al. Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two cages by finite element analysis. Spine, 2006, 31(19): E682-E689.

1. Spiker W R, Goz V, Brodke D S. Lumbar interbody fusions for degenerative spondylolisthesis: review of techniques, indications, and outcomes. Global Spine J, 2019, 9(1): 77-84.
2. 韋江波, 宋躍明, 劉立岷, 等. 腰椎椎間融合堅強固定與彈性固定生物力學效果的三維有限元分析. 生物醫學工程學雜志, 2015, 32(2): 316-320.
3. 張振軍, 廖振華, 孫藝萄, 等. 腰椎椎間融合器及其在椎間融合術中的生物力學研究進展. 醫用生物力學, 2018, 33(5): 465-470.
4. Xu D S, Walker C T, Godzik J, et al. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med, 2018, 6(6): 104.
5. 劉政, 李宏偉, 王海洲, 等. 腰椎融合術式研究進展. 醫學綜述, 2018, 24(11): 2175-2180.
6. 顏文濤, 趙改平, 方新果, 等. 經椎間孔腰椎椎間融合術式模型的生物力學研究. 生物醫學工程學雜志, 2015, 32(1): 67-72.
7. Sim H B, Murovic J A, Cho B Y, et al. Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segments laboratory investigation. J Neurosurg Spine, 2010, 12(6): 700-708.
8. Palepu V, Helgeson M D, Molyneaux-Francis M, et al. The effects of bone microstructure on subsidence risk for ALIF, LLIF, PLIF, and TLIF spine cages. J Biomech Eng, 2018, 141(3): 031002.
9. Fan W, Guo L X. A comparison of the influence of three different lumbar interbody fusion approaches on stress in the pedicle screw fixation system: finite element static and vibration analyses. Int J Numer Method Biomed Eng, 2019, 35(3): e3162.
10. 張振軍, 李文釗, 李慧, 等. 多孔鈦腰椎融合器在不同入路椎間融合術中的生物力學性能. 醫用生物力學, 2019, 34(3): 243-250.
11. Wilder D G, Pope M H. Epidemiological and aetiological aspects of low back pain in vibration environments. Clin Biomech, 1996, 11(2): 61-73.
12. Fan W, Guo L X. Prediction of the influence of vertical whole-body vibration on biomechanics of spinal segments after lumbar interbody fusion surgery. Clin Biomech, 2021, 86: 105389.
13. Rohlmann A, Hinz B, Blüthner R, et al. Loads on a spinal implant measured in vivo during whole-body vibration. Eur Spine J, 2010, 19(7): 1129-1135.
14. 吳楠, 裴葆青, 王唯, 等. 后路椎間融合術后全腰椎模態分析. 醫用生物力學, 2018, 33(4): 320-325.
15. Xu M, Yang J, Lieberman I, et al. The effect of surgical alignment in adult scoliotic spines on axial cyclic vibration: a finite element study. J Comput Inf Sci Eng, 2019, 19(2): 021006.
16. Fan W, Guo L X. The effect of non-fusion dynamic stabilization on biomechanical responses of the implanted lumbar spine during whole-body vibration. Comput Methods Programs Biomed, 2020, 192: 105441.
17. Guo L X, Fan W. Dynamic response of the lumbar spine to whole-body vibration under a compressive follower preload. Spine, 2018, 43(3): E143-E153.
18. Peck J H, Kavlock K D, Showalter B L, et al. Mechanical performance of lumbar intervertebral body fusion devices: an analysis of data submitted to the Food and Drug Administration. J Biomech, 2018, 78(3): 87-93.
19. Más Y, Gracia L, Ibarz E, et al. Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations. PLoS One, 2017, 12(11): e0188328.
20. Lo H J, Chen C S, Chen H M, et al. Application of an interspinous process device after minimally invasive lumbar decompression could lead to stress redistribution at the pars interarticularis: a finite element analysis. BMC Musculoskelet Disord, 2019, 20(1): 213.
21. 馬亮, 許永濤, 佘遠舉. 腰椎融合聯合上一節段棘突間動態固定的有限元分析. 中國組織工程研究, 2018, 22(23): 3647-3653.
22. Agarwal A, Palepu V, Agarwal A K, et al. Biomechanical evaluation of an endplate-conformed polycaprolactone-hydroxyapatite intervertebral fusion graft and its comparison with a typical nonconformed cortical graft. J Biomech Eng, 2013, 135(6): 61005-61009.
23. Li J, Wang W K, Zuo R, et al. Biomechanical stability before and after graft fusion with unilateral and bilateral pedicle screw fixation: finite element study. World Neurosurg, 2019, 123: e228-e234.
24. Shen H K, Chen Y R, Liao Z H, et al. Biomechanical evaluation of anterior lumbar interbody fusion with various fixation options: finite element analysis of static and vibration conditions. Clin Biomech, 2021, 84: 105339.
25. 項嬪, 都承斐, 莫中軍, 等. 不同振動載荷刺激對 L1-L5 腰椎的生物力學響應研究. 生物醫學工程學雜志, 2015, 32(1): 48-54.
26. Xu M, Yang J, Lieberman I, et al. Finite element method-based study for effect of adult degenerative scoliosis on the spinal vibration characteristics. Comput Biol Med, 2017, 84: 53-58.
27. Guo L X, Fan W. The effect of single-level disc degeneration on dynamic response of the whole lumbar spine to vertical vibration. World Neurosurg, 2017, 105: 510-518.
28. Fan Ruoxun, Liu Jie, Liu Jun. Finite element investigation on the dynamic mechanical properties of low-frequency vibrations on human L2-L3 spinal motion segments with different degrees of degeneration. Med Biol Eng Comput, 2020, 58(12): 3003-3016.
29. Kim H J, Bak K H, Chun H J, et al. Posterior interspinous fusion device for one-level fusion in degenerative lumbar spine disease: comparison with pedicle screw fixation - preliminary report of at least one year follow up. J Korean Neurosurg Soc, 2012, 52(4): 359-364.
30. Spicher A, Schmoelz W, Schmid R, et al. Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures. Biomed Tech (Berl), 2020, 65(2): 183-189.
31. Lo C C, Tsai K J, Zhong Z C, et al. Biomechanical differences of Coflex-F and pedicle screw fixation combined with TLIF or ALIF-a finite element study. Comput Methods Biomech Biomed Engin, 2011, 14(11): 947-956.
32. Chiang M F, Zhong Z C, Chen C S, et al. Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two cages by finite element analysis. Spine, 2006, 31(19): E682-E689.

Journal of Biomedical Engineering

Biomechanical study of different approach for lumbar interbody fusion surgeries under vibration load

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