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BMC Musculoskeletal Disorders

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Open Access 01-12-2019 | Research article

Effect of lordosis on adjacent levels after lumbar interbody fusion, before and after removal of the spinal fixator: a finite element analysis

Authors: Fon-Yih Tsuang, Jui-Chang Tsai, Dar-Ming Lai

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Abstract

Background

Literature indicates that adjacent-segment diseases after posterior lumbar interbody fusion with pedicle screw fixation accelerate degenerative changes at unfused adjacent segments due to the increased motion and intervertebral stress. Sagittal alignment of the spine is an important consideration as achieving proper lordosis could improve the outcome of spinal fusion and avoid the risk of adjacent segment diseases. Therefore, restoration of adequate lumbar lordosis is considered as a major factor in the long-term success of lumbar fusion. This study hypothesized that the removal of internal fixation devices in segments that have already fused together could reduce stress at the disc at adjacent segments, particularly in patients with inadequate lordosis. The purpose of this study was to analyze the biomechanical characteristics of a single fusion model (posterior lumbar interbody fusion with internal fixation) with different lordosis angles before and after removal of the internal fixation device.

Methods

Five finite element models were constructed for analysis; 1) Intact lumbar spine without any implants (INT), 2) Lumbar spine implanted with a spinal fixator and lordotic intervertebral cage at L4-L5 (FUS-f-5c), 3) Lumbar spine after removal of the spinal fixator (FUS-5c), 4) Lumbar spine implanted with a spinal fixator and non-lordotic intervertebral cage at L4-L5 (FUS-f-0c), and 5) Lumbar spine after removal of the spinal fixator from the FUS-f-0c model (FUS-0c).

Results

The ROM of adjacent segments in the FUS-f-0c model was found to be greater than in the FUS-f-5c model. After removing the fixator, the adjacent segments in the FUS-5c and FUS-0c models had a ROM that was similar to the intact spine under all loading conditions. Removing the fixator also reduced the contact forces on adjacent facet joints and reduced the peak stresses on the discs at adjacent levels. The greatest increase in stress on the discs was found in the FUS-f-0c model (at both L2/L3 and L3/L4), with intervertebral stress at L3/L4 increasing by 83% when placed in flexion.

Conclusions

This study demonstrated how removing the spinal fixation construct after bone fusion could reduce intradiscal pressure and facet contact forces at adjacent segments, while retaining a suitable level of lumbar lordosis.

Periasamy K, Shah K, Wheelwright EF. Posterior lumbar interbody fusion using cages, combined with instrumented posterolateral fusion: a study of 75 cases. Acta Orthop Belg [Internet]. 2008 Apr [cited 2019 Sep 9];74(2):240–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18564483.

Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM. Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) [Internet]. 2000 Jun 1 [cited 2018 Nov 22];25(11):1437–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10828927.

Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Kawaguchi S, Takebayashi T, et al. Adjacent segment stenosis after lumbar fusion requiring second operation. J Orthop Sci [Internet]. 2005 Sep [cited 2018 Nov 22];10(5):490–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16193361.CrossRef

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 Mar 1;39:5.

Nakashima H, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, et al. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases With a Minimum of 10 Years of Follow-up. Spine (Phila Pa 1976) [Internet]. 2015 Jul 15 [cited 2019 Sep 9];40(14):E831–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25839385.

Okuda S, Nagamoto Y, Matsumoto T, Sugiura T, Takahashi Y, Iwasaki M. Adjacent Segment Disease after Single Segment Posterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis. Spine (Phila Pa 1976) [Internet]. 2018 May 1 [cited 2018 Nov 22];43(23):1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29794583.

Jiang S, Li W. Biomechanical study of proximal adjacent segment degeneration after posterior lumbar interbody fusion and fixation: a finite element analysis. J Orthop Surg Res 2019 May 15;14(1).

Hartmann F, Dietz SO, Kuhn S, Hely H, Rommens PM, Gercek E. Biomechanical comparison of an interspinous device and a rigid stabilization on lumbar adjacent segment range of motion. Acta Chir Orthop Traumatol Cech [Internet]. 2011 [cited 2019 Sep 9];78(5):404–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22094153.

Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW, et al. The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976) [Internet]. 2000 Jul 1 [cited 2018 Nov 23];25(13):1617–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10870136.

10.

Chen CS, Cheng CK, Liu CL, Lo WH. Stress analysis of the disc adjacent to interbody fusion in lumbar spine. Med Eng Phys [Internet]. 2001 Sep [cited 2018 Nov 23];23(7):483–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11574255.CrossRef

11.

Hsieh Y-Y, Chen C-H, Tsuang F-Y, Wu L-C, Lin S-C, Chiang C-J. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis. Clin Biomech [Internet]. 2017 Mar [cited 2018 Nov 23];43:115–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28259005.CrossRef

12.

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) [Internet]. 2004 Sep 1 [cited 2018 Nov 23];29(17):1938–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15534420.

13.

Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J [Internet]. 2001 Aug [cited 2018 Nov 23];10(4):314–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11563617.CrossRef

14.

Zhao X, Du L, Xie Y, Zhao J. Effect of Lumbar Lordosis on the Adjacent Segment in Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurg [Internet]. 2018 Jun [cited 2018 Nov 23];114:e114–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29477002.

15.

Goldstein JA, Macenski MJ, Griffith SL, McAfee PC. Lumbar sagittal alignment after fusion with a threaded interbody cage. Spine (Phila Pa 1976) [Internet]. 2001 May 15 [cited 2018 Nov 23];26(10):1137–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11413426.

16.

Shih S-L, Chen C-S, Lin H-M, Huang L-Y, Liu C-L, Huang C-H, et al. Effect of Spacer Diameter of the Dynesys Dynamic Stabilization System on the Biomechanics of the Lumbar Spine. J Spinal Disord Tech [Internet]. 2012 Jul [cited 2018 Nov 21];25(5):E119–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22744611.

17.

Shih S-L, Liu C-L, Huang L-Y, Huang C-H, Chen C-S. Effects of cord pretension and stiffness of the Dynesys system spacer on the biomechanics of spinal decompression- a finite element study. BMC Musculoskelet Disord [Internet]. 2013 Dec 19 [cited 2018 Nov 22];14(1):191. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23777265.

18.

Dreischarf M, Zander T, Shirazi-Adl A, Puttlitz CM, Adam CJ, Chen CS, et al. Comparison of eight published static finite element models of the intact lumbar spine: Predictive power of models improves when combined together. J Biomech [Internet]. 2014 Jun 3 [cited 2018 Nov 22];47(8):1757–66. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24767702.CrossRef

19.

Panjabi MM. Hybrid multidirectional test method to evaluate spinal adjacent-level effects. Clin Biomech [Internet]. 2007 Mar [cited 2018 Nov 22];22(3):257–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17196720.

20.

Gao X, Wang L, Li S, Wang P, Zhang J, Shen Y. Predictors for Postoperative Loss of Lumbar Lordosis After Long Fusions Arthrodesis in Patients with Adult Scoliosis. Med Sci Monit [Internet]. 2018 Jan 27 [cited 2018 Nov 23];24:531–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29374139.

21.

Jeon C-H, Lee H-D, Lee Y-S, Seo J-H, Chung N-S. Is It Beneficial to Remove the Pedicle Screw Instrument After Successful Posterior Fusion of Thoracolumbar Burst Fractures? Spine (Phila Pa 1976) [Internet]. 2015 Jun 1 [cited 2018 Nov 23];40(11):E627–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26091158.

Title: Effect of lordosis on adjacent levels after lumbar interbody fusion, before and after removal of the spinal fixator: a finite element analysis
Authors: Fon-Yih Tsuang
Jui-Chang Tsai
Dar-Ming Lai
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-019-2886-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effect of lordosis on adjacent levels after lumbar interbody fusion, before and after removal of the spinal fixator: a finite element analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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