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.	韦江波, 宋跃明, 刘立岷, 等. 腰椎椎间融合坚强固定与弹性固定生物力学效果的三维有限元分析. 生物医学工程学杂志, 2015, 32(2): 316-320.
3.	张振军, 廖振华, 孙艺萄, 等. 腰椎椎间融合器及其在椎间融合术中的生物力学研究进展. 医用生物力学, 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.	刘政, 李宏伟, 王海洲, 等. 腰椎融合术式研究进展. 医学综述, 2018, 24(11): 2175-2180.
6.	颜文涛, 赵改平, 方新果, 等. 经椎间孔腰椎椎间融合术式模型的生物力学研究. 生物医学工程学杂志, 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.	张振军, 李文钊, 李慧, 等. 多孔钛腰椎融合器在不同入路椎间融合术中的生物力学性能. 医用生物力学, 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.	吴楠, 裴葆青, 王唯, 等. 后路椎间融合术后全腰椎模态分析. 医用生物力学, 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.	马亮, 许永涛, 佘远举. 腰椎融合联合上一节段棘突间动态固定的有限元分析. 中国组织工程研究, 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.	项嫔, 都承斐, 莫中军, 等. 不同振动载荷刺激对 L1-L5 腰椎的生物力学响应研究. 生物医学工程学杂志, 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. 韦江波, 宋跃明, 刘立岷, 等. 腰椎椎间融合坚强固定与弹性固定生物力学效果的三维有限元分析. 生物医学工程学杂志, 2015, 32(2): 316-320.
3. 张振军, 廖振华, 孙艺萄, 等. 腰椎椎间融合器及其在椎间融合术中的生物力学研究进展. 医用生物力学, 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. 刘政, 李宏伟, 王海洲, 等. 腰椎融合术式研究进展. 医学综述, 2018, 24(11): 2175-2180.
6. 颜文涛, 赵改平, 方新果, 等. 经椎间孔腰椎椎间融合术式模型的生物力学研究. 生物医学工程学杂志, 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. 张振军, 李文钊, 李慧, 等. 多孔钛腰椎融合器在不同入路椎间融合术中的生物力学性能. 医用生物力学, 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. 吴楠, 裴葆青, 王唯, 等. 后路椎间融合术后全腰椎模态分析. 医用生物力学, 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. 马亮, 许永涛, 佘远举. 腰椎融合联合上一节段棘突间动态固定的有限元分析. 中国组织工程研究, 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. 项嫔, 都承斐, 莫中军, 等. 不同振动载荷刺激对 L1-L5 腰椎的生物力学响应研究. 生物医学工程学杂志, 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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