Three-dimensional finite element analysis of the
biomechanical changes of the lumbar spine after the combination of
intervertebral fusion with dynamic internal fixation of the interspinous
process in the lumbosacral region

doi:10.3969/j.issn.2095-4344.2543

Abstract

Abstract:

BACKGROUND: The Topping-off technique, which combines lumbar fusion with the dynamic internal fixation system (Coflex), can not only reduce the pressure, but also protect the adjacent segments. There is no relevant mechanical analysis performed on the rationality of the application of Topping-off technique to young patients with the need for fusion on the lumbosacral region and adjacent degenerated segments.

OBJECTIVE: To establish a finite element model of Topping-off surgery on the lumbosacral junction and to analyze the biomechanical changes of the adjacent segments and the range of motion trend of the lumbar spine.

METHODS: A healthy young male volunteer with no previous history of low back pain or congenital malformations was randomly selected for thin-slice CT scanning after signed the informed consent. The image information was imported into the computer and the whole lumbar spine model as the healthy group model was established by analyzing the image information through Mimics, Geomagic Studio 12.0, HyperMesh and Abaqus successively. After verifying the effectiveness of the model, the moderate degeneration model of intervertebral disc was established by changing the material properties of L₄-S₁ discs on the basis of the healthy model, and the fusion model and Topping-off model were respectively established on the basis of the degeneration model. After applying 400 N compressive load and 10 N•m momentum to the four groups of models, the variation trends of range of motion from L₂ to L₅ and the stress changes of L₄/L₅ intervertebral disc, nucleus pulposus and facet joints were calculated respectively.

RESULTS AND CONCLUSION: (1) Compared with the degeneration model, the lumbar range of motion of Topping-off model and fusion model decreased, and the Topping-off model decreased more significantly than the fusion model. (2) The range of motion of fusion model L₄-L₅ increased significantly and the range of motion of L₂/L₃ and L₃/L₄ segments did not change significantly. Compared with the degeneration model, the L₄-L₅ range of motion of Topping-off model decreased, and range of motion of the L₂/L₃ and L₃/L₄ levels increased to some extent in the flexion and extension positions. (3) Compared with the degeneration model, the stress on the disc, nucleus pulposus and facet joint of the fusion model L₄-L₅ increased in four positions of flexion, extension, rotation and bending, while the fiber stress on the Topping-off model decreased significantly in all four positions. (4) These results suggest that Topping-off technology can not only reduce the stress on the upper adjacent degenerative intervertebral disc, nucleus pulposus and facet joints, but also reduce the hyperactivity of the adjacent segments and increase the range of motion of other upper segments, thereby compensating the lumbar spine mobility and delaying the degeneration of upper adjacent segments.

Key words: lumbar spinal fusion, Topping-off, finite element analysis, biomechanics, range of motion, adjacent segment degeneration

CLC Number:

Cao Liangliang, Xu Jianguang, Mei Wei. Three-dimensional finite element analysis of the biomechanical changes of the lumbar spine after the combination of intervertebral fusion with dynamic internal fixation of the interspinous process in the lumbosacral region[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(12): 1905-1910.

Figures/Tables 5

References

[1] MANNION AF, LEIVSETH G, BROX JI, et al. ISSLS Prize winner: Long-term follow-up suggests spinal fusion is associated with increased adjacent segment disc degeneration but without influence on clinical outcome: results of a combined follow-up from 4 randomized controlled trials. Spine. 2014; 39(17):1373-1383.
[2] 慕春黎,王朋. PLIF术后邻近节段退变的危险因素分析[J]. 中国骨与关节损伤杂志, 2019,34(1):87-89.
[3] CHEN XL, GUAN L, LIU YZ, et al. Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years. Int Orthop. 2016;40(6):1275-1283.
[4] FAIZAN A, SAIRYO K, GOEL VK, et al. Biomechanical rationale of ossification of the secondary ossification center on apophyseal bony ring fracture: a biomechanical study. Clin Biomech. 2007;22(10):1063-1067.
[5] SYLVESTRE PL, VILLEMURE I, AUBIN CE, et al. Finite element modeling of the growth plate in a detailed spine model. Med Biol Eng Comput. 2007;45(10):977-988.
[6] KUMARESAN S, YOGANANDAN N, PINTAR FA, et al. Contribution of disc degeneration to osteophyte formation in the cervical spine:: a biomechanical investigation. J Orthop Res. 2001; 19(5):977-984.
[7] POLIKEIT A, NOLTE LP, FERGUSON SJ, et al. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit. Spine. 2003;28(10):991-996.
[8] BYUN DH, SHIN DA, KIM JM, et al. Finite Element Analysis of the Biomechanical. Korean J Spine. 2012;9(3):131-136.
[9] KULDUK A, ALTUN NS, SENKOYLU A, et al. Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine: a finite element study. Int J Med Robot. 2015;11(4): 400-405.
[10] FAN W, GUO LX. 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):3162.
[11] HETH JA, HITCHON PW, GOEL VK, et al. A biomechanical comparison between anterior and transverse interbody fusion cages. Spine. 2001; 26(12):261-267.
[12] LU S, WANG Z, FAU N, et al. Establishment and biomechanical analysis of three-dimensional nonlinear finite element model of three-pieces segment arch. Hua Xi Kou Qiang Yi Xue Za Zhi. 2013; 31(1):74-79.
[13] DONG F. The contributions of facet joint to the stiffness of the lumbar spine. Zhonghua Wai Ke Za Zhi. 1993;31(7):417-420.
[14] YAMAMOTO I, PANJABI MM, CRISCO T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine. 1989;14(11):1256-1260.
[15] SOBOTTKE, R, BRUST KS, KAULHAUSEN T, et al. Interspinous implants (X Stop, Wallis, Diam) for the treatment of LSS: is there a correlation between radiological parameters and clinical outcome? Eur Spine J. 2009;18(10):1494-1503.
[16] GALA RJ, RUSSO GS, WHANG PG, et al. Interspinous implants to treat spinal stenosis. Curr Rev Musculoskelet Med. 2017; 10(2):182-188.
[17] LANDI A. Interspinous posterior devices: What is the real surgical indication? World J Clin Cases. 2014;2(9):402-408.
[18] LIANG J, DONG Y, ZHAO H. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion. J Orthop Surg Res. 2014; 9:97.
[19] 曹宗锐,郑博,屈博,等. ISObar+TTL动态固定系统治疗双节段腰椎椎间盘突出症:8年随访[J].中国组织工程研究,2019,23(32): 5110-5116.
[20] PFIRRMANN WA, METZDORF A, ZANETTI M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001; 26(17):1873-1878.
[21] LI D, HAI Y, MENG X, et al. Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration. J Orthop Surg Res. 2019;14(1):197.
[22] ZHU Z, LIU C, WANG K, et al. Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res. 2015;10:10.
[23] NIU CC, CHEN YLF, HUEI L. Beneficial effects of hyperbaric oxygen on human degenerated intervertebral disk cells via suppression of IL-1beta and p38 MAPK signal. J Orthop Res. 2011; 29(1):14-19.
[24] MURAKAMI H, YOON TS, ATTALLAH-WASIF ES, et al. Quantitative differences in intervertebral disc-matrix composition with age-related degeneration. Med Biol Eng Comput. 2010; 48(5):469-474.
[25] HIRSCH C. Studies on the pathology of low back pain. J Bone Joint Surg Br. 1959; 41-B(2):237-243.
[26] TENCER AF, MAYER TG. Soft tissue strain and facet face interaction in the lumbar intervertebral joint--Part II: Calculated results and comparison with experimental data. J Biomech Eng. 1983; 105(3):210-215.
[27] 曹亮亮,徐建广,连小峰,等. Topping-off术后上位相邻节段的MRI表现及近期疗效[J].中国矫形外科杂志,2017,25(17): 1552-1557.
[28] KOZANEK M, WANG S, PASSIAS PG, et al. Range of motion and orientation of the lumbar facet joints in vivo. Spine, 2009; 34(19):689-696.
[29] JONES-QUAIDOO SM, DJURASOVIC M, OWENS RK 2ND, et al. Superior articulating facet violation: percutaneous versus open techniques. J Neurosurg Spine. 2013;18(6): 593-597.