Screw stress features of the posterior asymmetric or symmetric fixation of transforaminal lumbar fusion based on a three-dimensional finite element method

doi:10.3969/j.issn.2095-4344.2013.09.006

Abstract

Abstract:

BACKGROUND: Biomechanical investigation had discovered that effectiveness of the posterior asymmetric fixation based on transforaminal lumbar fusion is similar to double side pedicle screws fixation, which can meet the clinical biomechanical requirement. How is the transfacetopedicular screw security in posterior asymmetric fixation after transforaminal lumbar fusion?
OBJECTIVE: To develop three-dimensional finite element model of L₄-₅segment treated with posterior ipsilateral pedicle screws supplemented with contralateral transfacetopedicular screw fixation, posterior ipsilateral pedicle screws supplemented with contralateral translaminarfacet screw fixation and posterior bilateral pedicle screws fixation after transforaminal lumbar fusion respectively and treated with the same load, in order to evaluate the stress of the screws under different kinestates and the stress of three kinds of screws combined fixation in transforaminal lumbar fusion.
METHODS: The geometrical model was created by Mimics 11.1 based on CT data of L₄/₅ motion segment, fusion cage, pedicle screws and os integumentale screw from an adult man. Different fixation models after left transforaminal lumbar fusion including the following sequentially test configurations: ipsilateral pedicle screws+contralateral translaminarfacet screw; ipsilateral pedicle screws+contralateral transfacetopedicular screw; bilateral pedicle screws. Subsequently, the above models were imported into the Simpleware 3.1 in order to establish the three-dimensional finite element models. 500 N\6 Nm loading was loaded on the upper surface of L4 of transforaminal lumbar fusion supplement with three types of fixations to simulate lumbar flexion, extension, lateral bending and axial rotation. The three-dimensional finite element models were imported into Abaqus 6.8 to analyze the stress changes and stress distribution of screws.
RESULTS AND CONCLUSION: Left facet joint was removed in transforaminal lumbar fusion procedure, leading to asymmetry stress attribution of internal implants. For rigid pedicle screws fixation, they were more influenced by asymmetry stress attribution, especially under left axial rotation. In asymmetry fixation, the stress of ipsilateral pedicle screws was increased accordingly due to the influence of transfacetopedicular screw, especially under left axial rotation. However, the breakage risk of screws remained lower under rotation controlled properly. For stepping down the risk of pedicle screws fatigue breakage, the axial rotation after three kinds of fixation based on transforaminal lumbar fusion should be restrict severely, especially the axial rotation on the side that facet joint was destroyed.

Key words: bone and joint implants, spinal implants, lumbar, spinal fusion, pedicle screw, facet fixation, facet pedicle screw fixation, translaminar facet screws, finite element, peak stress, photographs-containing paper of bone and joint implants

CLC Number:

R318

Ao Jun, Wan Lei, Liao Wen-bo, Xue Zhong-lin, Yu Bo, Jin An-min. Screw stress features of the posterior asymmetric or symmetric fixation of transforaminal lumbar fusion based on a three-dimensional finite element method[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(9): 1555-1562.

Figures/Tables 6

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