Computational comparison of three posterior lumbar interbody fusion techniques by using porous titanium interbody cages with 50% porosity

This study investigated the biomechanical response of porous cages and lumbar spine segments immediately after surgery and after bone fusion, in addition to the long-term effects of various posterior lumbar interbody fusion (PLIF) techniques, by using the finite element method. Lumbar L3-L4 models based on three PLIF techniques (a single cage at the center of the intervertebral space, a single cage half-anterior to the intervertebral space, and two cages bilateral to the intervertebral space) with and without bone ingrowth were used to determine the biomechanical response of porous cages and lumbar segments instrumented with porous titanium cages (cage porosity=50%, pore diameter=1mm). The results indicated that bone fusion enhanced the stability of the lumbar segments with porous cages without any posterior instrumentation and reduced the peak von Mises stress in the cortical bones and porous cages. Two cages placed bilateral to the intervertebral space achieved the highest structural stability in the lumbar segment and lowest von Mises stress in the cages under both bone fusion conditions. Under identical loading (2-Nm), the range of motion in the single cage at the center of the intervertebral space with bone fusion decreased by 11% (from 1.18° to 1.05°) during flexion and by 66.5% (from 4.46° to 1.5°) during extension in the single cage half-anterior to the intervertebral space with bone fusion compared with no-fusion models. Thus, two porous titanium cages with 50% porosity can achieve high stability of a lumbar segment with PLIF. If only one cage is available, placing the cage half-anterior to the intervertebral space is recommended for managing degenerated lumbar segments.

[1]  L. Murr,et al.  Compression deformation behavior of Ti-6Al-4V alloy with cellular structures fabricated by electron beam melting. , 2012, Journal of the mechanical behavior of biomedical materials.

[2]  J Dubousset,et al.  A Biomechanical Analysis of Short Segment Spinal Fixation Using a Three-Dimensional Geometric and Mechanical Model , 1993, Spine.

[3]  Max Jägersberg,et al.  Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion , 2015, Journal of Clinical Neuroscience.

[4]  N. Langrana,et al.  Role of Ligaments and Facets in Lumbar Spinal Stability , 1995, Spine.

[5]  Antonius Rohlmann,et al.  Comparison of the biomechanical effects of posterior and anterior spine-stabilizing implants , 2005, European Spine Journal.

[6]  Chia-Ying Lin,et al.  Porous biodegradable lumbar interbody fusion cage design and fabrication using integrated global-local topology optimization with laser sintering. , 2013, Journal of biomechanical engineering.

[7]  V. Valderrábano,et al.  Ankle fusion with a trabecular metal spacer and an anterior fusion plate. , 2015, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[8]  Shih-Jung Liu,et al.  Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis , 2014 .

[9]  A. Shirazi-Adl,et al.  Experimental determination of friction characteristics at the trabecular bone/porous-coated metal interface in cementless implants. , 1993, Journal of biomedical materials research.

[10]  H. Anderson,et al.  The effect of a stiff spinal implant on the bone-mineral content of the lumbar spine in dogs. , 1991, The Journal of bone and joint surgery. American volume.

[11]  A Shirazi-Adl,et al.  Biomechanics of the Lumbar Spine in Sagittal/Lateral Moments , 1994, Spine.

[12]  E Schneider,et al.  Structure and Function of Vertebral Trabecular Bone , 1997, Spine.

[13]  Zhi-Yong Zhang,et al.  Porous titanium-6 aluminum-4 vanadium cage has better osseointegration and less micromotion than a poly-ether-ether-ketone cage in sheep vertebral fusion. , 2013, Artificial organs.

[14]  M. Schlee,et al.  Prospective, Multicenter Evaluation of Trabecular Metal-Enhanced Titanium Dental Implants Placed in Routine Dental Practices: 1-Year Interim Report From the Development Period (2010 to 2011). , 2015, Clinical implant dentistry and related research.

[15]  S. L. Griffith,et al.  Revision strategies for salvaging or improving failed cylindrical cages. , 1999, Spine.

[16]  E. Ng,et al.  Evaluation of dentinal fluid flow behaviours: a fluid-structure interaction simulation , 2014, Computer methods in biomechanics and biomedical engineering.

[17]  Yi He,et al.  A minimally invasive posterior lumbar interbody fusion using percutaneous long arm pedicle screw system for degenerative lumbar disease. , 2014, International journal of clinical and experimental medicine.

[18]  T. Whitecloud,et al.  Degenerative conditions of the lumbar spine treated with intervertebral titanium cages and posterior instrumentation for circumferential fusion. , 1998, Journal of spinal disorders.

[19]  D. Maiman,et al.  Biomechanics of polyaryletherketone rod composites and titanium rods for posterior lumbosacral instrumentation. Presented at the 2010 Joint Spine Section Meeting. Laboratory investigation. , 2010, Journal of neurosurgery. Spine.

[20]  A. Ducati,et al.  Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up , 2006, Acta Neurochirurgica.

[21]  Martijn van Dijk,et al.  The Effect of Cage Stiffness on the Rate of Lumbar Interbody Fusion: An In Vivo Model Using Poly(L-Lactic Acid) and Titanium Cages , 2002, Spine.

[22]  A B Schultz,et al.  Effects of fluid injection on mechanical properties of intervertebral discs. , 1979, Journal of biomechanics.

[23]  R. Singer,et al.  Cellular Ti-6Al-4V structures with interconnected macro porosity for bone implants fabricated by selective electron beam melting. , 2008, Acta biomaterialia.

[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. Kaneda,et al.  In vitro biomechanical investigation of the stability and stress-shielding effect of lumbar interbody fusion devices. , 2000, Journal of neurosurgery.

[26]  J. Hsu,et al.  The effect of material inhomogeneous for femoral finite element analysis , 2002 .

[27]  P. Lachiewicz,et al.  Porous metal metaphyseal cones for severe bone loss: when only metal will do. , 2014, The bone & joint journal.

[28]  S. L. Griffith,et al.  The Bagby and Kuslich Method of Lumbar Interbody Fusion: History, Techniques, and 2‐Year Follow‐up Results of a United States Prospective, Multicenter Trial , 1998, Spine.

[29]  A. M. Ahmed,et al.  Stress analysis of the lumbar disc-body unit in compression. A three-dimensional nonlinear finite element study. , 1984, Spine.

[30]  Hutton Wc,et al.  Do bending, twisting, and diurnal fluid changes in the disc affect the propensity to prolapse? A viscoelastic finite element model , 1996 .

[31]  R. Fraser,et al.  Radiologic Assessment of Interbody Fusion Using Carbon Fiber Cages , 2003, Spine.

[32]  Che-Hsin Lin,et al.  Experimental and numerical estimations into the force distribution on an occlusal surface utilizing a flexible force sensor array. , 2011, Journal of biomechanics.

[33]  W. Lo,et al.  Stress analysis of the disc adjacent to interbody fusion in lumbar spine. , 2001, Medical engineering & physics.

[34]  Shivakumar Raman,et al.  Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM). , 2010, Journal of the mechanical behavior of biomedical materials.

[35]  Fabio Galbusera,et al.  Biomechanical analysis of cages for posterior lumbar interbody fusion. , 2007, Medical engineering & physics.

[36]  Cheng-Feng Lin,et al.  Finite Element Analysis of Plantar Fascia During Walking , 2015, Foot & ankle international.

[37]  A. Schultz,et al.  Mechanical Properties of Human Lumbar Spine Motion Segments: Influences of Age, Sex, Disc Level, and Degeneration , 1979, Spine.

[38]  E. Helseth,et al.  Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage) , 2010, BMC surgery.

[39]  Chia-Ying Lin,et al.  Interbody Fusion Cage Design Using Integrated Global Layout and Local Microstructure Topology Optimization , 2004, Spine.

[40]  M. Lamghari,et al.  Osteoblast adhesion and morphology on TiO2 depends on the competitive preadsorption of albumin and fibronectin. , 2008, Journal of biomedical materials research. Part A.

[41]  H. Schrøder,et al.  Outcome of revision total knee arthroplasty with the use of trabecular metal cone for reconstruction of severe bone loss at the proximal tibia. , 2014, The Knee.

[42]  Stephen J. Ferguson,et al.  Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis , 2003, European Spine Journal.

[43]  E. Ng,et al.  An investigation of dentinal fluid flow in dental pulp during food mastication: simulation of fluid–structure interaction , 2014, Biomechanics and modeling in mechanobiology.

[44]  S. Khurana,et al.  Clinical and radiographic outcomes after spinous process fixation and posterior fusion in an elderly cohort. , 2014, Surgical technology international.

[45]  Michel Assad,et al.  Porous titanium-nickel for intervertebral fusion in a sheep model: part 1. Histomorphometric and radiological analysis. , 2003, Journal of biomedical materials research. Part B, Applied biomaterials.

[46]  M M Panjabi,et al.  Effects of preload on load displacement curves of the lumbar spine. , 1977, The Orthopedic clinics of North America.

[47]  T. Tullberg,et al.  Failure of a Carbon Fiber Implant: A Case Report , 1998, Spine.

[48]  Bernard H. Sagherian,et al.  Salvage of Failed Total Ankle Replacement Using Tantalum Trabecular Metal: Case Series , 2015, Foot & ankle international.

[49]  Shinn-Zong Lin,et al.  Efficacy of anterior cervical fusion: Comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts , 2008, Journal of Clinical Neuroscience.

[50]  P. Ullrich,et al.  Osteoblasts exhibit a more differentiated phenotype and increased bone morphogenetic protein production on titanium alloy substrates than on poly-ether-ether-ketone. , 2012, The spine journal : official journal of the North American Spine Society.

[51]  R. Deyo,et al.  United States Trends in Lumbar Fusion Surgery for Degenerative Conditions , 2005, Spine.

[52]  Chih-Han Chang,et al.  Role of the compression screw in the dynamic hip-screw system: A finite-element study. , 2015, Medical engineering & physics.

[53]  P. Lipinski,et al.  Development and mechanical characterization of porous titanium bone substitutes. , 2012, Journal of the mechanical behavior of biomedical materials.

[54]  D E Macdonald,et al.  Titanium alloy surface oxide modulates the conformation of adsorbed fibronectin to enhance its binding to α(5) β(1) integrins in osteoblasts. , 2012, European journal of oral sciences.

[55]  Barbara D Boyan,et al.  Additively manufactured 3D porous Ti-6Al-4V constructs mimic trabecular bone structure and regulate osteoblast proliferation, differentiation and local factor production in a porosity and surface roughness dependent manner , 2014, Biofabrication.

[56]  S. Kurtz,et al.  PEEK biomaterials in trauma, orthopedic, and spinal implants. , 2007, Biomaterials.