Finite element analysis of lumbar interbody fusion combined
with adjacent-segment semi-rigid fixation

doi:10.3969/j.issn.2095-4344.2580

Abstract

Abstract:

BACKGROUND: The clinical occurrence of lumbar degenerative diseases is often accompanied by multi-segments lesions. To slow down the degeneration of adjacent segments after lumbar fusion, lumbar hybrid surgery has become a better choice. In the past clinical observation, WavefleX system has achieved a certain effect on single segment. Its application in lumbar hybrid surgery lacks the support of biomechanical research results.

OBJECTIVE: To analyze the biomechanical effects of lumbar fusion combined with WavefleX system on adjacent segments by the finite element method.

METHODS: A 64-row Siemens spiral CT machine was used to scan the lumbar spine of a stationary supine volunteer with a scanning range of T₁₁-S₁. This voluntter signed the informed consent. This study was approved by the Hospital Ethics Committee. L₃_-₅ horizontal scanning data were imported into the Mimics medical image processing software and the Geomagic studio reverse engineering software for processing. L₃_-₅ lumbar spine solid model was constructed in the CAD software SCDM. On the basis of L₃_-₅lumbar model, posterior lumbar interbody fusion model and Hybrid model were constructed respectively. Assignment and load loading were conducted in three models. The finite element analysis was carried out under the conditions of forward flexion, backward extension, lateral flexion and rotation.

RESULTS AND CONCLUSION: (1) Compared with posterior lumbar interbody fusion model, the stress value of L₃_-₄ disc in Hybrid model decreased significantly in forward flexion, backward extension, lateral flexion and rotation, and the maximum value decreased about 46% in extension. (2) Compared with posterior lumbar interbody fusion model, the range of motion of L₃_-₄segment in Hybrid model decreased significantly, with an average decrease of about 26%, which was smaller than that of the complete model under all conditions. (3) Under each load, the stress nephogram showed that there was an obvious stress concentration on the connecting rod of WavefleX system, and the stress at the U-shaped groove concave of the elastic system on both sides was significantly increased. (4) Displacement nephogram showed the placement of WavefleX system in Hybrid model, which made its forward bending center moved back to the elastic structure. (5) The above results show that posterior lumbar interbody fusion + WavefleX semi-rigid fixation can effectively reduce the stress of the last adjacent segment of the disc and limit the excessive activity, maintain the normal movement characteristics of the lumbar spine to a certain extent.

Key words: lumbar spine, adjacent segment, degeneration, WavefleX system, finite element analysis, Hybrid surgery, stress

CLC Number:

Wang Xiao, Tan Guoqing, Xue Haipeng, Xu Zhanwang.

Finite element analysis of lumbar interbody fusion combined with adjacent-segment semi-rigid fixation [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(15): 2361-2367.

Figures/Tables 10

References

[1] SCHMOELZ W, ERHART S, UNGER S, et al. Biomechanical evaluation of aposterior non -fusion instrumentation of the lumbar spine. Eur Spine J. 2012;21(5):939-945.
[2] MOBBS RJ, PHAN K, MALHAM G, et al.Lumbar interbody fusion:techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18.
[3] SÉNÉGAS J, VITAL JM, POINTILLART V, et al. Long-term actuarial survivorship analysis of an interspinous stabilization system. Eur Spine J. 2007;16: 1279-1287.
[4] 张兆川,姜效韦,戴维享, 等.WavefleX弹性固定与髓核摘除纤维环修复重建腰椎间盘突出患者脊柱稳定性[J].中国组织工程研究,2015,19(44):7131-7136.
[5] 朱小广,丁亮华,姜世涛,等.腰椎后路经椎弓根动态固定系统研究新进展[J].中国脊柱脊髓杂志,2011,21(3):252-255.
[6] 谭国庆,甘东浩,陈德强, 等.WavefleX内固定系统在多节段腰椎退行性疾病术中的应用[J].中国骨与关节损伤杂志,2017,32(5): 508-510.
[7] 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[J].中国组织工程研究,2018,22(23):3647-3653.
[8] CHENG CK, CHEN CS, LIU CL. Biomechanical analysis of the lumbar spine with anterior interbody fusion on the different locations of the bone grafts. Biomed Mater Eng. 2002;12(4): 367-374.
[9] POLIKEIT A, FERGUSON SJ, NOLTE LP, et al. Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis.Eur Spine J. 2002; 12(4):413-420.
[10] GOEL VK, MONROE BT, GILBERTSON LG, et al. Interlaminar shear stresses and laminae separation in a disc. Finite element analysis of the L3-L4 motion segment subjected to axial compressive loads.Spine.1976;20(6): 689-698.
[11] DING JY, QIAN S, WAN L, et al. Design and finite-element evaluation of a versatile assembled lumbar interbody fusion cage. Arch Orthop Trauma Surg. 2010;130(4):565-571.
[12] SONG C, LI XF, LIU ZD, et al. Biomechanical assessment of a novel L4/5 level interspinous implant using three dimensional finite element analysis. Eur Rev Med Pharmacol Sci. 2014;18(18):86-94.
[13] DUAN Y, WANG HH, JIN AM, et al. Finite element analysis of posterior cervical fixation. Orthop Traumatol Surg Res. 2015; 101(1):23-29.
[14] 陶勇,吴云乐,宗少晖,等.基于有限元分析腰椎内固定的生物力学特征[J].中国组织工程研究,2016,20(13):1932-1938.
[15] HETH JA, HITCHON PW, GOEL VK, et al.A biomechanical comparison between anterior and transverse interbody fusion cages.Spine.2001;26(12):e26 1-e267.
[16] YAMAMOTO I, PUNJABI MM, CRISCO T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine. 1989;14(11):1256·1260.
[17] CHEN WJ, LAI PL, NIU CC, et al.Surgical treatment of adjacent instability after lumbar spine fusion.Spine. 2001;26: 519-524.
[18] LAI PL, CHEN LH, NIU CC, et al.Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation.Spine. 2004;29: 2527-2532.
[19] ISHIHARA H, OSADA R, KANAMORI M, et al.Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis.J Spinal Disord. 2001;14( 2):91-99.
[20] MIYAKOSHI N, ABE E, SHIMADA Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion.Spine ( Phila Pa 1976). 2000;25(14) : 1837-1842.
[21] 张克非,闫明,刘军.老年患者腰椎融合术后邻近节段退变的研究进展[J].实用老年医学,2015,29(11):892-894.
[22] 陈辉,吴小涛,王运涛,等.腰椎后柱“骨-腱-骨”结构的完整性对邻近节段生物力学的影响[J].现代医学,2007,35(6):454-457.
[23] HILIBRAND AS, ROBBINS M.Adjacent segment degeneration and adjacent segment disease:the consequences of spinal fusion.Spine. 2004;4(6 Suppl): 190-194.
[24] CHEN SJ. Can hybrid constructs prevent adjacent segments degeneration? Long-term follow-up results. Spine J. 2019.
[25] RAHM MD, HALL BB. Adjacent segment degeneration after lumbar fusion with instrumentation: a retrospective study. Spinal Disord.1996;9(5):392-400.
[26] RADCLIFF KE, KEPLER CK, JAKOI A, et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J. 2013;13(10):1339-1349.
[27] KASHKOUSH A, AGARWAL N, PASCHEL E, et al. Evaluation of a hybrid dynamic stabilization and fusion system in the lumbar spine: a 10 year experience. Cureus. 2016;8(6):e637.
[28] NACHANAKIAN A, EL HELOU A, ALAYWAN M. Posterior dynamic stabilization:The interspinous spacer from treatment to prevention. Asian J Neurosurg. 2016;11(2):87-93.
[29] LEE SE, JAHNG TA, KIM HJ. Facet joint changes after application of lumbar nonfusion dynamic stabilization. Neurosurg Focus. 2016;40(1):E6.
[30] CABELLO J, CAVANILLES-WALKER JM, IBORRA M, et al. The protective role of dynamic stabilization on the adjacent disc to a rigid instrumented level. An in vitro biomechanical analysis. Arch Orthop Trauma Surg. 2013;133(4):443-448.
[31] LIU HY, ZHOU J, WANG B, et al. Comparison of topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease: a retrospective study. Chin Med J. 2012;125(22):3942-3946.
[32] 胡明,马远征,李大伟,等.WavefleX动态稳定系统治疗腰椎退变性疾病的早期临床观察[J].中国骨与关节外科, 2013,6(2): 113-116.
[33] 薛有地,王栋,戴维享,等.WavefleX内固定系统治疗多节段腰椎退变疾病的中期疗效[J].中国修复重建外科杂志, 2015,29(9): 1104-1108.