Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Research article

Biomechanical analysis of single-level interbody fusion with different internal fixation rod materials: a finite element analysis

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Lumbar spinal fusion with rigid spinal fixators as one of the high risk factors related to adjacent-segment failure. The purpose of this study is to investigate how the material properties of spinal fixation rods influence the biomechanical behavior at the instrumented and adjacent levels through the use of the finite element method.

Methods

Five finite element models were constructed in our study to simulate the human spine pre- and post-surgery. For the four post-surgical models, the spines were implanted with rods made of three different materials: (i) titanium rod, (ii) PEEK rod with interbody PEEK cage, (iii) Biodegradable rod with interbody PEEK cage, and (iv) PEEK cage without pedicle screw fixation (no rods).

Results

Fusion of the lumbar spine using PEEK or biodegradable rods allowed a similar ROM at both the fusion and adjacent levels under all conditions. The models with PEEK and biodegradable rods also showed a similar increase in contact forces at adjacent facet joints, but both were less than the model with a titanium rod.

Conclusions

Flexible rods or cages with non-instrumented fusion can mitigate the increased contact forces on adjacent facet joints typically found following spinal fixation, and could also reduce the level of stress shielding at the bone graft.
Literature
1.
Fritzell P, Hägg O, Wessberg P, Nordwall A. Swedish Lumbar Spine Study Group Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976). 2002;27:1131–41.CrossRef
2.
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976). 1997;22:2807–12.CrossRef
3.
Etebar S, Cahill DW. Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg. 1999;90(2 Suppl):163–9.PubMed
4.
Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976). 2008;33(15):1701–7.CrossRef
5.
Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10:314–9.CrossRef
6.
Hikata T, Kamata M, Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease. J Spinal Disord Tech. 2014;27:70–5.CrossRef
7.
Faizan A, Goel VK, Biyani A, Garfin SR, Bono CM. Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine - a finite element based study. Clin Biomech (Bristol, Avon). 2012;27:226–33.CrossRef
8.
Ma J, Jia H, Ma X, Xu W, Yu J, Feng R, Wang J, Xing D, Wang Y, Zhu S, Yang Y, Chen Y, Ma B. Evaluation of the stress distribution change at the adjacent facet joints after lumbar fusion surgery: a biomechanical study. Proc Inst Mech Eng H. 2014;228(7):665–73.CrossRef
9.
Bastian L, Lange U, Knop C, Tusch G, Blauth M. Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study. Eur Spine J. 2001;10(4):295–300.CrossRef
10.
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(17):1938–44.CrossRef
11.
Gornet MF, Chan FW, Coleman JC, Murrell B, Nockels RP, Taylor BA, Lanman TH, Ochoa JA. Biomechanical assessment of a PEEK rod system for semi-rigid fixation of lumbar fusion constructs. J Biomech Eng. 2011;133(8):081009.CrossRef
12.
De Iure F, Bosco G, Cappuccio M, Paderni S, Amendola L. Posterior lumbar fusion by peek rods in degenerative spine: preliminary report on 30 cases. Eur Spine J. 2012;21(S1):50–4.CrossRef
13.
Bezer M, Yildirim Y, Erol B, Güven O. Absorbable self-reinforced polylactide (SR-PLLA) rods vs rigid rods (K-wire) in spinal fusion: an experimental study in rabbits. Eur Spine J. 2005;14:227–33.CrossRef
14.
Savage K, Sardar ZM, Pohjonen T, Sidhu GS, Eachus BD, Vaccaro A. Mechanical properties of bioresorbable self-reinforced posterior cervical rods. J Spinal Disord Tech. 2014;27(2):E66–71.CrossRef
15.
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.CrossRef
16.
Jeon CH, Lee HD, Lee YS, Seo JH, Chung NS. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine (Phila Pa 1976). 2015;40(11):E627–33.CrossRef
17.
Tsuang FY, Hsieh YY, Kuo YJ, Chen CH, Lin FH, Chen CS, Chiang CJ. Assessment of the suitability of biodegradable rods for use in posterior lumbar fusion: an in-vitro biomechanical evaluation and finite element analysis. PLoS One. 2017;12(11):e0188034.CrossRef
18.
Shih SL, Chen CS, Lin HM, Huang LY, Liu CL, Huang CH, Cheng CK. Effect of spacer diameter of the Dynesys dynamic stabilization system on the biomechanics of the lumbar spine: a finite element analysis. J Spinal Disord Tech. 2012;25(5):E140–9.CrossRef
19.
Shih SL, Liu CL, Huang LY, Huang CH, Chen CS. Effects of cord pretension and stiffness of the Dynesys system spacer on the biomechanics of spinal decompression-a finite element study. BMC Musculoskelet Disord. 2013;14(1):191.CrossRef
20.
Dreischarf M, Zander T, Shirazi-Adl A, Puttlitz CM, Adam CJ, Chen CS, Goel VK, Kiapour A, Kim YH, Labus KM, Little JP, Park WM, Wang TH, Wilke HJ, Rohlmann A, Schmidt H. Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together. J Biomech. 2014;47:1757–66.CrossRef
21.
Patel A, Welch WC. Posterior lumbar interbody fusion with metal cages: current techniques. Oper Tech Orthop. 2000;10(4):311–9.CrossRef
22.
Panjabi MM. Hybrid multidirectional test method to evaluate spinal adjacent-level effects. Clin Biomech. 2007;22(3):257–65.CrossRef
23.
Zhong ZC, Chen SH, Hung CH. Load- and displacement-controlled finite element analyses on fusion and non-fusion spinal implants. Proc Inst Mech Eng H. 2009;223(2):143–57.CrossRef
24.
Gedet P, Haschtmann D, Thistlethwaite PA, Ferguson SJ. Comparative biomechanical investigation of a modular dynamic lumbar stabilization system and the Dynesys system. Eur Spine J. 2009;18(10):1504–11.CrossRef
25.
Schmoelz W, Huber JF, Nydegger T, Dipl I, Claes L, Wilke HJ. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech. 2003;16(4):418–23.CrossRef
26.
Schmoelz W, Erhart S, Unger S, Disch AC. Biomechanical evaluation of a posterior non-fusion instrumentation of the lumbar spine. Eur Spine J. 2012;21(5):939–45.CrossRef
27.
Chou WK, Chien A, Wang JL. Biomechanical analysis between PEEK and titanium screw-rods spinal construct subjected to fatigue loading. J Spinal Disord Tech. 2015;28(3):E121–5.CrossRef
28.
Ahn YH, Chen WM, Lee KY, Park KW, Lee SJ. Comparison of the load-sharing characteristics between pedicle-based dynamic and rigid rod devices. Biomed Mater. 2008;3(4):44101.CrossRef
29.
Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC. Failure analysis of broken pedicle screws on spinal instrumentation. Med Eng Phys. 2005;27(6):487–96.CrossRef
30.
Ponnappan RK, Serhan H, Zarda B, Patel R, Albert T, Vaccaro AR. Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation. Spine J. 2009;9(3):263–7.CrossRef
31.
Krijnen MR, Mensch D, van Dieen JH, Wuisman PI, Smit TH. Primary spinal segment stability with a stand-alone cage: in vitro evaluation of a successful goat model. Acta Orthop. 2006;77(3):454–61.CrossRef
32.
Chen CS, Cheng CK, Liu CL, Lo WH. Stress analysis of the disc adjacent to interbody fusion in lumbar spine. Med Eng Phys. 2001;23(7):483–91.CrossRef
33.
Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine. 1988;13:375–7.CrossRef
34.
Schlegel JD, Smith JA, Schleusener RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Spine. 1996;21:970–81.CrossRef
35.
van Dijk M, Smit TH, Sugihara S, Burger EH, Wuisman PI. The effect of cage stiffness on the rate of lumbar interbody fusion. Spine. 2002;27:682–8.CrossRef
36.
Volkheimer D, Malakoutian M, Oxland TR, Wilke HJ. Limitations of current in vitro test protocols for investigation of instrumented adjacent segment biomechanics: critical analysis of the literature. Eur Spine J. 2015;24(9):1882–92.CrossRef
Metadata
Title
Biomechanical analysis of single-level interbody fusion with different internal fixation rod materials: a finite element analysis
Publication date
01-12-2020
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-3111-1

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Research article

Association between muscle strength and depressive symptoms among Chinese female college freshmen: a cross-sectional study

Research article

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Case report

Large osteochondral defect in the lateral femoral condyle reconstructed by Atelocollagen-associated autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction

Research article

Patient-reported outcome after patient-specific unicondylar knee arthroplasty for unicompartmental knee osteoarthritis

Research article

Activation of FoxO1/SIRT1/RANKL/OPG pathway may underlie the therapeutic effects of resveratrol on aging-dependent male osteoporosis

Research article

Quality of life in chronic musculoskeletal symptomatic Chilean population: secondary analysis of National Health Survey 2009–2010