Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2024 | Research article

Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study

Authors: Fei Huang, Gang Huang, Junpengli Jia, Shihao Lu, Jingchi Li

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

The capsule of the zygapophyseal joint plays an important role in motion segmental stability maintenance. Iatrogenic capsule injury is a common phenomenon in posterior approach lumbar interbody fusion operations, but whether this procedure will cause a higher risk of adjacent segment degeneration acceleration biomechanically has yet to be identified.

Methods

Posterior lumbar interbody fusion (PLIF) with different grades of iatrogenic capsule injury was simulated in our calibrated and validated numerical model. By adjusting the cross-sectional area of the capsule, different grades of capsule injury were simulated. The stress distribution on the cranial motion segment was computed under different loading conditions to judge the potential risk of adjacent segment degeneration acceleration.

Results

Compared to the PLIF model with an intact capsule, a stepwise increase in the stress value on the cranial motion segment can be observed with a step decrease in capsule cross-sectional areas. Moreover, compared to the difference between models with intact and slightly injured capsules, the difference in stress values was more evident between models with slight and severe iatrogenic capsule injury.

Conclusion

Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically, and iatrogenic capsule damage on the cranial motion segment should be reduced to optimize patients’ long-term prognosis.

Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, Santaguida C, Smith JS. The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery. 2015;77(Suppl 4):S1-5.PubMedCrossRef

Heuck A, Glaser C. Basic aspects in MR imaging of degenerative lumbar disk disease. Seminars Musculoskeletal Radiol. 2014;18:228–39.CrossRef

Ferguson SJ, Steffen T. Biomechanics of the aging spine. Eur Spine J. 2003;12(Suppl 2):S97-s103.PubMedPubMedCentralCrossRef

Lerner A, Mogensen MA, Kim PE, Shiroishi MS, Hwang DH, Law M. Clinical applications of diffusion tensor imaging. World Neurosurg. 2014;82:96–109.PubMedCrossRef

Adams MA, Dolan P. Biomechanics of vertebral compression fractures and clinical application. Arch Orthop Trauma Surg. 2011;131:1703–10.PubMedCrossRef

Adams MA, Dolan P. Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat. 2012;221:497–506.PubMedPubMedCentralCrossRef

Athanasakopoulos M, Mavrogenis AF, Triantafyllopoulos G, Koufos S, Pneumaticos SG. Posterior spinal fusion using pedicle screws. Orthopedics. 2013;36:e951-957.PubMedCrossRef

Goh JC, Wong HK, Thambyah A, Yu CS. Influence of PLIF cage size on lumbar spine stability. Spine (Phila Pa 1976) 2000; 25:35–39; discussion 40.

Bagheri SR, Alimohammadi E, Zamani Froushani A, Abdi A. Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: incidence and risk factors. J Orthop Surg (Hong Kong). 2019;27:2309499019842378.PubMedCrossRef

10.

Bydon M, Macki M, Kerezoudis P, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. The incidence of adjacent segment disease after lumbar discectomy: a study of 751 patients. J Clin Neurosci. 2017;35:42–6.PubMedCrossRef

11.

Ou CY, Lee TC, Lee TH, Huang YH. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease. Neurosurgery 2015, 76:396–401; discussion 401–392; quiz 402.

12.

Hashimoto K, Aizawa T, Kanno H, Itoi E. Adjacent segment degeneration after fusion spinal surgery-a systematic review. Int Orthop. 2019;43:987–93.PubMedCrossRef

13.

Lee JC, Kim Y, Soh JW, Shin BJ. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: comparison of posterior lumbar interbody fusion and posterolateral fusion. Spine (Phila Pa 1976) 2014, 39:E339–345.

14.

Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine (Phila Pa 1976) 2000;25:1625–36.

15.

Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine (Phila Pa 1976) 2006;31:2151–61.

16.

Hsieh YY, Chen CH, Tsuang FY, Wu LC, Lin SC, Chiang CJ. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: a finite element analysis. Clin Biomech (Bristol, Avon). 2017;43:115–20.PubMedCrossRef

17.

Kaito T, Hosono N, Mukai Y, Makino T, Fuji T, Yonenobu K. Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space. J Neurosurg Spine. 2010;12:671–9.PubMedCrossRef

18.

Oh KW, Lee JH, Lee JH, Lee DY, Shim HJ. The correlation between cage subsidence, bone mineral density, and clinical results in posterior lumbar interbody fusion. Clin Spine Surg. 2017;30:E683-e689.PubMedCrossRef

19.

Schnake KJ, Rappert D, Storzer B, Schreyer S, Hilber F, Mehren C. Lumbar fusion-Indications and techniques. Der Orthopade. 2019;48:50–8.PubMedCrossRef

20.

Li J, Xu C, Zhang X, Xi Z, Sun S, Zhang K, Fang X, Xie L, Liu Y, Song Y. Disc measurement and nucleus calibration in a smoothened lumbar model increases the accuracy and efficiency of in-silico study. J Orthop Surg Res. 2021;16:498.PubMedPubMedCentralCrossRef

21.

Xu C, Xi Z, Fang Z, Zhang X, Wang N, Li J, Liu Y. Annulus calibration increases the computational accuracy of the lumbar finite element model. Global Spine J. 2022;21925682221081224.

22.

Li JC, Xie TH, Zhang Z, Song ZT, Song YM, Zeng JC. The mismatch between bony endplates and grafted bone increases screw loosening risk for OLIF patients with ALSR fixation biomechanically. Front Bioeng Biotechnol. 2022;10:862951.PubMedPubMedCentralCrossRef

23.

Li JC, Yang ZQ, Xie TH, Song ZT, Song YM, Zeng JC. Deterioration of the fixation segment’s stress distribution and the strength reduction of screw holding position together cause screw loosening in ALSR fixed OLIF patients with poor BMD. Front Bioeng Biotechnol. 2022;10:922848.PubMedPubMedCentralCrossRef

24.

Zhao FD, Pollintine P, Hole BD, Adams MA, Dolan P. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone. 2009;44:372–9.PubMedCrossRef

25.

Liu JT, Han H, Gao ZC, He CY, Cai X, Niu BB, Gu MC, Li YH, Liang H, He XJ. CT assisted morphological study of lumbar endplate. Zhongguo gu shang = China J Orthopaedics Traumatol. 2018; 31:1129–35.

26.

Pan CL, Zhang BY, Zhu YH, Ma YH, Li MF, Wang X, Yang F, Li YQ, Zhu YH. Morphologic analysis of Chinese lumbar endplate by three-dimensional computed tomography reconstructions for helping design lumbar disc prosthesis. Medicine. 2021;100:e24583.PubMedPubMedCentralCrossRef

27.

DeLucca JF, Cortes DH, Jacobs NT, Vresilovic EJ, Duncan RL, Elliott DM. Human cartilage endplate permeability varies with degeneration and intervertebral disc site. J Biomech. 2016;49:550–7.PubMedPubMedCentralCrossRef

28.

Jacobs NT, Cortes DH, Peloquin JM, Vresilovic EJ, Elliott DM. Validation and application of an intervertebral disc finite element model utilizing independently constructed tissue-level constitutive formulations that are nonlinear, anisotropic, and time-dependent. J Biomech. 2014;47:2540–6.PubMedPubMedCentralCrossRef

29.

Jacobs E, Roth AK, Arts JJ, van Rhijn LW, Willems PC. Reduction of intradiscal pressure by the use of polycarbonate-urethane rods as compared to titanium rods in posterior thoracolumbar spinal fixation. J Mater Sci Mater Med. 2017;28:148.PubMedPubMedCentralCrossRef

30.

Li J, Xie Y, Sun S, Xue C, Xu W, Xu C, Xi Z. Regional differences in bone mineral density biomechanically induce a higher risk of adjacent vertebral fracture after percutaneous vertebroplasty: a case-comparative study. Int J Surg (London, England) 2023.

31.

Spina NT, Moreno GS, Brodke DS, Finley SM, Ellis BJ. Biomechanical effects of laminectomies in the human lumbar spine: a finite element study. Spine J. 2021;21:150–9.PubMedCrossRef

32.

Zhang Q, Chon T, Zhang Y, Baker JS, Gu Y. Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads. Comput Biol Med. 2021;136:104745.PubMedCrossRef

33.

Schmidt H, Heuer F, Drumm J, Klezl Z, Claes L, Wilke HJ. Application of a calibration method provides more realistic results for a finite element model of a lumbar spinal segment. Clin Biomech (Bristol, Avon). 2007;22:377–84.PubMedCrossRef

34.

Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z, Wang N, Xie L, Song Y. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskelet Disord. 2021;22:616.PubMedPubMedCentralCrossRef

35.

Renner SM, Natarajan RN, Patwardhan AG, Havey RM, Voronov LI, Guo BY, Andersson GB, An HS. Novel model to analyze the effect of a large compressive follower pre-load on range of motions in a lumbar spine. J Biomech. 2007;40:1326–32.PubMedCrossRef

36.

Schilling C, Krüger S, Grupp TM, Duda GN, Blömer W, Rohlmann A. The effect of design parameters of dynamic pedicle screw systems on kinematics and load bearing: an in vitro study. Eur Spine J. 2011;20:297–307.PubMedCrossRef

37.

Wilson DC, Niosi CA, Zhu QA, Oxland TR, Wilson DR. Accuracy and repeatability of a new method for measuring facet loads in the lumbar spine. J Biomech. 2006;39:348–53.PubMedCrossRef

38.

Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873–8.

39.

Sengul E, Ozmen R, Yaman ME, Demir T. Influence of posterior pedicle screw fixation at L4–L5 level on biomechanics of the lumbar spine with and without fusion: a finite element method. Biomed Eng. 2021;20:98.

40.

Kaito T, Hosono N, Fuji T, Makino T, Yonenobu K. Disc space distraction is a potent risk factor for adjacent disc disease after PLIF. Arch Orthop Trauma Surg. 2011;131:1499–507.PubMedCrossRef

41.

Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg (Hong Kong). 2015;1:2–18.

42.

Huang C, Liu Z, Wei Z, Fang Z, Xi Z, Cai P, Li J. Will the adjustment of insertional pedicle screw positions affect the risk of adjacent segment diseases biomechanically? An in-silico study. Front Surg. 2022;9:1004642.PubMedCrossRef

43.

Xu C, Huang C, Cai P, Fang Z, Wei Z, Liu F, Li J, Liu Y. Biomechanical effects of pedicle screw positioning on the surgical segment in models after oblique lumbar interbody fusion: an in-silico study. Int J Gen Med. 2022;15:1047–56.PubMedPubMedCentralCrossRef

44.

Xi Z, Xie Y, Chen S, Sun S, Zhang X, Yang J, Li J. The cranial vertebral body suffers a higher risk of adjacent vertebral fracture due to the poor biomechanical environment in patients with percutaneous vertebralplasty. Spine J. 2023.

45.

Kashii M, Kitaguchi K, Makino T, Kaito T. Comparison in the same intervertebral space between titanium-coated and uncoated PEEK cages in lumbar interbody fusion surgery. J Orthopaedic Sci. 2020;25:565–70.CrossRef

46.

Zeng ZL, Jia L, Xu W, Yu Y, Hu X, Jia YW, Wang JJ, Cheng LM. Analysis of risk factors for adjacent superior vertebral pedicle-induced facet joint violation during the minimally invasive surgery transforaminal lumbar interbody fusion: a retrospective study. Eur J Med Res. 2015;20:80.PubMedPubMedCentralCrossRef

47.

Oh HS, Seo HY. The relationship between adjacent segment pathology and facet joint violation by pedicle screw after posterior Lumbar instrumentation surgery. J Clin Med. 2021;10.

48.

Bermel EA, Barocas VH, Ellingson AM. The role of the facet capsular ligament in providing spinal stability. Comput Methods Biomech Biomed Engin. 2018;21:712–21.PubMedPubMedCentralCrossRef

49.

Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br. 1984;66:706–10.PubMedCrossRef

50.

Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 2004;29:1938–44.

51.

Zhong ZM, Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors. Clin Neurol Neurosurg. 2017;156:29–34.PubMedCrossRef

52.

Sharma A, Lancaster S, Bagade S, Hildebolt C. Early pattern of degenerative changes in individual components of intervertebral discs in stressed and nonstressed segments of lumbar spine: an in vivo magnetic resonance imaging study. Spine (Phila Pa 1976) 2014;39:1084–90.

53.

Ozer AF, Oktenoglu T, Sasani M, Kaner T, Ercelen O, Canbulat N. Unusual cause of acute low-back pain: sudden annulus fibrosus rupture. Orthop Rev (Pavia). 2012;4:e22.PubMed

54.

Khalaf K, Nikkhoo M. Comparative biomechanical analysis of rigid vs. flexible fixation devices for the lumbar spine: A geometrically patient-specific poroelastic finite element study. Comput Methods Programs Biomed. 2021; 212:106481.

55.

Yokoyama K, Yamada M, Tanaka H, Ito Y, Sugie A, Wanibuchi M, Kawanishi M. Factors of adjacent segment disease onset after microsurgical decompression for lumbar spinal canal stenosis. World Neurosurg. 2020;144:e110–8.PubMedCrossRef

56.

Ruetten S, Komp M. Endoscopic lumbar decompression. Neurosurg Clin N Am. 2020;31:25–32.PubMedCrossRef

57.

Schmidt H, Heuer F, Simon U, Kettler A, Rohlmann A, Claes L, Wilke HJ. Application of a new calibration method for a three-dimensional finite element model of a human lumbar annulus fibrosus. Clin Biomech (Bristol, Avon). 2006;21:337–44.PubMedCrossRef

Title: Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study
Authors: Fei Huang
Gang Huang
Junpengli Jia
Shihao Lu
Jingchi Li
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04550-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative capsule protection can reduce the potential risk of adjacent segment degeneration acceleration biomechanically: an in silico study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Bupivacaine–fentanyl isobaric spinal anesthesia reduces the risk of ICU admission in elderly patients undergoing lower limb orthopedic surgery

Letter to the Editor about the article: Reconstruction of a 3D printed endoprosthesis after joint preservation surgery with intraoperative physeal distraction for childhood malignancies of the distal femur

Bone marrow lesion and 5-year incident joint surgery in patients with knee osteoarthritis: a retrospective cohort study

Combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of a mid-distal adjacent finger defect: a retrospective study

Factors influencing the posterior cruciate ligament buckling phenomenon—a multiple linear regression analysis of bony and soft tissue structures of the knee joint

Comparison of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) with bilateral decompression via unilateral approach and open-TLIF with bilateral decompression for degenerative lumbar diseases: a retrospective cohort study