Development of an integrated CAD–FEA system for patient-specific design of spinal cages

Abstract Spinal cages are used to create a suitable mechanical environment for interbody fusion in cases of degenerative spinal instability. Due to individual variations in bone structures and pathological conditions, patient-specific cages can provide optimal biomechanical conditions for fusion, strengthening patient recovery. Finite element analysis (FEA) is a valuable tool in the biomechanical evaluation of patient-specific cage designs, but the time- and labor-intensive process of modeling limits its clinical application. In an effort to facilitate the design and analysis of patient-specific spinal cages, an integrated CAD–FEA system (CASCaDeS, comprehensive analytical spinal cage design system) was developed. This system produces a biomechanical-based patient-specific design of spinal cages and is capable of rapid implementation of finite element modeling. By comparison with commercial software, this system was validated and proven to be both accurate and efficient. CASCaDeS can be used to design patient-specific cages with a superior biomechanical performance to commercial spinal cages.

[1]  J. Evans,et al.  The load bearing capacity of vertebral cancellous bone in interbody fusion of the lumbar spine. , 1983, Engineering in medicine.

[2]  A. Schultz,et al.  Load-displacement properties of lower cervical spine motion segments. , 1988, Journal of biomechanics.

[3]  J. R. Parsons,et al.  Mechanics of interbody spinal fusion. Analysis of critical bone graft area. , 1993, Spine.

[4]  T. Keller Predicting the compressive mechanical behavior of bone. , 1994, Journal of biomechanics.

[5]  A. Thambyah,et al.  Influence of PLIF Cage Size on Lumbar Spine Stability , 2000, Spine.

[6]  Gabriel Taubin,et al.  Geometric Signal Processing on Polygonal Meshes , 2000, Eurographics.

[7]  M. Shoham,et al.  Morphometric Study of the Human Lumbar Spine for Operation–Workspace Specifications , 2001, Spine.

[8]  L. Claes,et al.  Resistance of the Lumbar Spine Against Axial Compression Forces after Implantation of Three Different Posterior Lumbar Interbody Cages , 2001, Acta Neurochirurgica.

[9]  C. Fisher,et al.  The effects of bone density and disc degeneration on the structural property distributions in the lower lumbar vertebral endplates , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  S. Blumenthal,et al.  Intervertebral cages for degenerative spinal diseases. , 2003, The spine journal : official journal of the North American Spine Society.

[11]  Madjid Samii,et al.  3D-segmentation and finite element modelling of spine segments , 2003, CARS.

[12]  T. Lowe,et al.  A Biomechanical Study of Regional Endplate Strength and Cage Morphology as It Relates to Structural Interbody Support , 2004, Spine.

[13]  John E. Renaud,et al.  Optimum design of an interbody implant for lumbar spine fixation , 2005, Adv. Eng. Softw..

[14]  G. Dumas,et al.  Evaluation of effects of selected factors on inter-vertebral fusion-a simulation study. , 2005, Medical engineering & physics.

[15]  J. Tan,et al.  The Effect of Interbody Cage Positioning on Lumbosacral Vertebral Endplate Failure in Compression , 2005, Spine.

[16]  Zheng-Cheng Zhong,et al.  Finite element analysis of the lumbar spine with a new cage using a topology optimization method. , 2006, Medical engineering & physics.

[17]  P. Barša,et al.  Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion , 2007, European Spine Journal.

[18]  Yue Zhou,et al.  [The biomechanical change of lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction: report of 23 cases]. , 2008, Zhonghua yi xue za zhi.

[19]  S C Wang,et al.  Heterogeneous meshing and biomechanical modeling of human spine. , 2007, Medical engineering & physics.

[20]  G. J. Verkerke,et al.  Geometry of the Intervertebral Volume and Vertebral Endplates of the Human Spine , 2009, Annals of Biomedical Engineering.

[21]  Nicole M. Grosland,et al.  IA-FEMesh: An open-source, interactive, multiblock approach to anatomic finite element model development , 2009, Comput. Methods Programs Biomed..

[22]  Sim Heng Ong,et al.  A component-oriented software toolkit for patient-specific finite element model generation , 2009, Adv. Eng. Softw..

[23]  Shih-Hao Chen,et al.  Biomechanical comparison between lumbar disc arthroplasty and fusion. , 2009, Medical engineering & physics.

[24]  Y. Tsuang,et al.  Comparison of cage application modality in posterior lumbar interbody fusion with posterior instrumentation--a finite element study. , 2009, Medical engineering & physics.

[25]  K. Kang,et al.  Comparison of radiographic and computed tomographic measurement of pedicle and vertebral body dimensions in Koreans: the ratio of pedicle transverse diameter to vertebral body transverse diameter , 2011, European Spine Journal.

[26]  H. Chuah,et al.  Topology optimisation of spinal interbody cage for reducing stress shielding effect , 2010, Computer methods in biomechanics and biomedical engineering.

[27]  Frank L. Hammond,et al.  The effect of implant size and device keel on vertebral compression properties in lumbar total disc replacement. , 2010, The spine journal : official journal of the North American Spine Society.

[28]  N. de Beer,et al.  Reducing subsidence risk by using rapid manufactured patient-specific intervertebral disc implants. , 2012, The spine journal : official journal of the North American Spine Society.

[29]  Pierre Jean Arnoux,et al.  Method to Geometrically Personalize a Detailed Finite-Element Model of the Spine , 2013, IEEE Transactions on Biomedical Engineering.

[30]  Ching-Chi Hsu,et al.  Shape optimization for the subsidence resistance of an interbody device using simulation‐based genetic algorithms and experimental validation , 2013, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[31]  Amir A Zadpoor,et al.  Patient-specific bone modeling and analysis: the role of integration and automation in clinical adoption. , 2015, Journal of biomechanics.