Biomechanical Evaluation of Different Sizes of 3D Printed Cage in Lumbar Interbody Fusion-a Finite Element Analysis

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2023 Feb 2

PMID 36726086

Authors

Jincheng Wu

Qing Feng

Dongmei Yang

Hanpeng Xu

Wangqiang Wen

Haoxiang Xu

Jun Miao

Affiliations

Soon will be listed here.

Abstract

Objective: To study the biomechanical characteristics of various tissue structures of different sizes of 3D printed Cage in lumbar interbody fusion.

Methods: A finite element model of normal spine was reconstructed and verified. Pedicle screws and Cage of different sizes were implanted in the L4/5 segment to simulate lumbar interbody fusion. The range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment were calculated and analyzed.

Results: The range of motion and intervertebral disc pressure of the adjacent segment of each postoperative model were larger than those of the intact model, but there was not much difference between them. The stress of cage-endplate interface was also larger than that of the intact model. However, the difference is that the stress of the endplate and the screw-rod system has a tendency to decrease with the increase of the axial area of cage.

Conclusions: Cage with larger axial area in lumbar interbody fusion can reduce the stress of internal fixation system and endplate, but will not increase the range of motion and intervertebral disc pressure of adjacent segment. It has a certain effect in preventing the cage subsidence, internal fixation system failure and screw rod fracture.

Citing Articles

The biomechanical effects of treating double-segment lumbar degenerative diseases with unilateral fixation through interlaminar fenestration interbody fusion surgery: a three-dimensional finite element study.

Feng K, Xiang X, Li C, Gao K, Zhang W, Nie Z BMC Musculoskelet Disord. 2025; 26(1):40.

PMID: 39794739 PMC: 11724487. DOI: 10.1186/s12891-025-08287-7.

Application of 3D printing technology in preoperative planning and treatment of proximal humerus fractures: a retrospective study.

Li D, Zhou R, Song C, Lu J, Lu J BMC Musculoskelet Disord. 2024; 25(1):962.

PMID: 39593054 PMC: 11590292. DOI: 10.1186/s12891-024-08060-2.

Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.

You K, Cho S, Hwang J, Cha S, Kang M, Park S Neurospine. 2024; 21(3):973-983.

PMID: 39363473 PMC: 11456953. DOI: 10.14245/ns.2448244.122.

The postoperative clinical effects of utilizing 3D printed (Ti6Al4V) interbody fusion cages in posterior lumbar fusion: A retrospective cohort study.

Wang Z, Zhang D, Zhang Z, Miao J Medicine (Baltimore). 2024; 103(25):e38431.

PMID: 38905365 PMC: 11191957. DOI: 10.1097/MD.0000000000038431.

Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis.

Zhou C, Meng X, Huang S, Chen H, Zhou H, Liao Y Heliyon. 2024; 10(5):e26726.

PMID: 38434291 PMC: 10907677. DOI: 10.1016/j.heliyon.2024.e26726.

References

Liang Z, Cui J, Zhang J, He J, Tang J, Ren H . Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?. BMC Musculoskelet Disord. 2020; 21(1):117. PMC: 7035718. DOI: 10.1186/s12891-020-3103-1. View

Kotheeranurak V, Jitpakdee K, Lin G, Mahatthanatrakul A, Singhatanadgige W, Limthongkul W . Subsidence of Interbody Cage Following Oblique Lateral Interbody Fusion: An Analysis and Potential Risk Factors. Global Spine J. 2021; 13(7):1981-1991. PMC: 10556923. DOI: 10.1177/21925682211067210. View

Huang Y, Du C, Cheng C, Zhong Z, Chen X, Wu G . Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis. PLoS One. 2016; 11(11):e0166452. PMC: 5117648. DOI: 10.1371/journal.pone.0166452. View

Kikuchi S . New concept for backache: biopsychosocial pain syndrome. Eur Spine J. 2008; 17 Suppl 4:421-7. PMC: 2587659. DOI: 10.1007/s00586-008-0747-1. View

Alizadeh M, Rafiq Abdul Kadir M, Fadhli M, Fallahiarezoodar A, Azmi B, Raman Murali M . The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: a finite element analysis. J Orthop Res. 2013; 31(9):1447-54. DOI: 10.1002/jor.22376. View

Fagan M, Julian S, Mohsen A . Finite element analysis in spine research. Proc Inst Mech Eng H. 2002; 216(5):281-98. DOI: 10.1243/09544110260216568. View

Liu C, Wang L, Xu Y, Chen C, Wang J, Tsai W . Traditional and cortical trajectory screws of static and dynamic lumbar fixation- a finite element study. BMC Musculoskelet Disord. 2020; 21(1):463. PMC: 7362474. DOI: 10.1186/s12891-020-03437-5. View

Shah F, Snis A, Matic A, Thomsen P, Palmquist A . 3D printed Ti6Al4V implant surface promotes bone maturation and retains a higher density of less aged osteocytes at the bone-implant interface. Acta Biomater. 2015; 30:357-367. DOI: 10.1016/j.actbio.2015.11.013. View

Polikeit A, Ferguson S, Nolte L, Orr T . Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis. Eur Spine J. 2003; 12(4):413-20. PMC: 3467788. DOI: 10.1007/s00586-002-0505-8. View

10.

Schnake K, Rappert D, Storzer B, Schreyer S, Hilber F, Mehren C . [Lumbar fusion-Indications and techniques]. Orthopade. 2018; 48(1):50-58. DOI: 10.1007/s00132-018-03670-w. View

11.

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. 2018; 114:e114-e120. DOI: 10.1016/j.wneu.2018.02.073. View

12.

Li C, Zhou Y, Wang H, Liu J, Xiang L . Treatment of unstable thoracolumbar fractures through short segment pedicle screw fixation techniques using pedicle fixation at the level of the fracture: a finite element analysis. PLoS One. 2014; 9(6):e99156. PMC: 4051693. DOI: 10.1371/journal.pone.0099156. View

13.

Formica M, Vallerga D, Zanirato A, Cavagnaro L, Basso M, Divano S . Fusion rate and influence of surgery-related factors in lumbar interbody arthrodesis for degenerative spine diseases: a meta-analysis and systematic review. Musculoskelet Surg. 2020; 104(1):1-15. DOI: 10.1007/s12306-019-00634-x. View

14.

Li Q, Long X, Shi L, Wang Y, Guan T, Lv J . Prevalence and risk factors for cage subsidence after lumbar interbody fusion: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021; 100(49):e28085. PMC: 8663804. DOI: 10.1097/MD.0000000000028085. View

15.

Maragkos G, Motiei-Langroudi R, Filippidis A, Glazer P, Papavassiliou E . Factors Predictive of Adjacent Segment Disease After Lumbar Spinal Fusion. World Neurosurg. 2019; 133:e690-e694. DOI: 10.1016/j.wneu.2019.09.112. View

16.

Song K, Choi B, Jeon T, Lee K, Chang H . Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments. Eur Spine J. 2011; 20(11):1940-5. PMC: 3207329. DOI: 10.1007/s00586-011-1864-9. View

17.

Hekimoglu M, Basak A, Yilmaz A, Yildirim H, Aydin A, Karadag K . Adjacent Segment Disease (ASD) in Incidental Segmental Fused Vertebra and Comparison With the Effect of Stabilization Systems on ASD. Cureus. 2021; 13(10):e18647. PMC: 8578681. DOI: 10.7759/cureus.18647. View

18.

Brinckmann P, Grootenboer H . Change of disc height, radial disc bulge, and intradiscal pressure from discectomy. An in vitro investigation on human lumbar discs. Spine (Phila Pa 1976). 1991; 16(6):641-6. DOI: 10.1097/00007632-199106000-00008. View

19.

Meng B, Bunch J, Burton D, Wang J . Lumbar interbody fusion: recent advances in surgical techniques and bone healing strategies. Eur Spine J. 2020; 30(1):22-33. DOI: 10.1007/s00586-020-06596-0. View

20.

Dorner T, Crevenna R . Preventive aspects regarding back pain. Wien Med Wochenschr. 2015; 166(1-2):15-21. DOI: 10.1007/s10354-015-0413-2. View