Skip to main content
SpringerLink
Log in

Biomechanical investigation of topping-off technique using an interspinous process device following lumbar interbody fusion under vibration loading

  • Original Article
  • Published:
Medical & Biological Engineering & Computing Aims and scope Submit manuscript

Abstract

Topping-off technique has been proposed to prevent adjacent-segment degeneration/disease following spine fusion surgery. Nevertheless, few studies have investigated biomechanics of the fusion surgery with topping-off device under whole-body vibration (WBV). This biomechanical study aimed to investigate the vibration characteristics of human lumbar spine after topping-off surgery, and also to evaluate the effect of bony fusion on spine biomechanics. Based on a healthy finite-element model of lumbosacral spine (L1–sacrum), the models of topping-off surgery before and after bony fusion were developed. The simulated surgical procedures consisted of interbody fusion with rigid stabilizer at L4–L5 segment (rigid fusion) and dynamic stabilizer at degenerated L3–L4 segment. An interspinous implant, Device for Intervertebral Assisted Motion (DIAM, Medtronic Inc., Minnesota, USA), was used as the dynamic stabilizer. The stress responses of spine segments and implants under a vertical cyclic load were calculated and analyzed. The results showed that compared with rigid fusion alone, the topping-off technique significantly decreased disc stress at transition segment (L3–L4) as expected, and resulted in a slight increase in disc stress at its supra-adjacent segment (L2–L3). It indicated that the topping-off stabilization using DIAM might provide a good tradeoff between protection of transition segment and deterioration of its supra-adjacent segment during WBV. Also, it was found that bony fusion decreased stress in L4 inferior endplate and rigid stabilizer but had nearly no effect on stress in DIAM and L3–L4 disc, which was helpful to determine the biomechanical differences before and after bony fusion.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Hashimoto K, Aizawa T, Kanno H, Itoi E (2019) Adjacent segment degeneration after fusion spinal surgery-a systematic review. Int Orthop 39(8):1459–1464

    Google Scholar 

  2. Xia XP, Chen HL, Cheng HB (2013) Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine 38(7):597–608

    Article  Google Scholar 

  3. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29(17):1938–1944

    Article  Google Scholar 

  4. Akamaru T, Kawahara N, Tim Yoon S, Minamide A, Su Kim K, Tomita K et al (2003) Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments: a biomechanical analysis. Spine 28(14):1560–1566

    PubMed  Google Scholar 

  5. Ma JX, Jia HB, Ma XL, Xu WG, Yu JT, Feng R et al (2014) Evaluation of the stress distribution change at the adjacent facet joints after lumbar fusion surgery: a biomechanical study. Proc Inst Mech Eng H 228(7):665–673

    Article  Google Scholar 

  6. Zhu ZQ, Liu CJ, Wang KF, Zhou J, Wang JF, Zhu Y et al (2015) Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res 10:10

    Article  CAS  Google Scholar 

  7. Cao LL, Liu YM, Mei W, Xu JG, Zhan S (2020) Biomechanical changes of degenerated adjacent segment and intact lumbar spine after lumbosacral topping-off surgery: a three-dimensional finite element analysis. BMC Musculoskelet Disord 21(1):104

    Article  Google Scholar 

  8. Cabello J, Cavanilles-Walker JM, Iborra M, Ubierna MT, Covaro A, Roca J (2013) The protective role of dynamic stabilization on the adjacent disc to a rigid instrumented level. An in vitro biomechanical analysis. Arch Orthop Trauma Surg 133(4):443–448

    Article  CAS  Google Scholar 

  9. Chen CS, Shih SL (2018) Biomechanical analysis of a new lumbar interspinous device with optimized topology. Med Biol Eng Comput 56(8):1333–1341

    Article  Google Scholar 

  10. Chou PH, Lin HH, An HS, Liu KY, Su WR, Lin CL (2017) Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review. Biomed Res Int 2017:4385620

    PubMed  PubMed Central  Google Scholar 

  11. Fan YP, Zhou SB, Xie T, Yu ZF, Han X, Zhu LL (2019) Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a finite element analysis. J Orthop Surg Res 14(1):476

    Article  Google Scholar 

  12. Wang W, Sun XY, Zhang TT, Sun SY, Kong C, Lu SB (2020) Topping-off technology versus posterior lumbar interbody fusion in the treatment of lumbar disc herniation: a meta-analysis. Biomed Res Int 2020:2953128

    PubMed  PubMed Central  Google Scholar 

  13. Wilke HJ, Drumm J, Häussler K, Mack C, Steudel WI, Kettler A (2008) Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure. Eur Spine J 17(8):1049–1056

    Article  Google Scholar 

  14. Lin HM, Liu CL, Pan YN, Huang CH, Shih SL, Wei SH et al (2014) Biomechanical analysis and design of a dynamic spinal fixator using topology optimization: a finite element analysis. Med Biol Eng Comput 52(5):499–508

    Article  Google Scholar 

  15. Kong C, Lu SB, Hai Y (2015) Zang L Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment. Clin Biomech 30(4):355–359

    Article  Google Scholar 

  16. Lee CH, Kim YE, Lee HJ, Kim DG, Kim CH (2017) Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw-based dynamic fixator. J Neurosurg Spine 27(6):643–649

    Article  Google Scholar 

  17. Xu M, Yang J, Lieberman I, Haddas R (2019) The effect of surgical alignment in adult scoliotic spines on axial cyclic vibration: a finite element study. J Comput Inf Sci Eng 19(2):UNSP 021006

    Article  Google Scholar 

  18. Goel VK, Park H, Kong WZ (1994) Investigation of vibration characteristics of the ligamentous lumbar spine using the finite element approach. J Biomech Eng 116(4):377–383

    Article  CAS  Google Scholar 

  19. Guo LX, Fan W (2018) Dynamic response of the lumbar spine to whole-body vibration under a compressive follower preload. Spine 43(3):E143–E153

    Article  Google Scholar 

  20. Bovenzi M, Schust M, Mauro M (2017) An overview of low back pain and occupational exposures to whole-body vibration and mechanical shocks. Med Lav 108(6):419–433

    PubMed  Google Scholar 

  21. Wade KR, Schollum ML, Robertson PA, Thambyah A, Broom ND (2016) ISSLS Prize Winner: Vibration really does disrupt the disc: a microanatomical investigation. Spine (Phila Pa 1976) 41(15):1185–1198

    Article  Google Scholar 

  22. Rohlmann A, Hinz B, Bluthner R, Graichen F, Bergmann G (2010) Loads on a spinal implant measured in vivo during whole-body vibration. Eur Spine J 19(7):1129–1135

    Article  Google Scholar 

  23. Fan W, Guo LX, Zhao D (2019) Stress analysis of the implants in transforaminal lumbar interbody fusion under static and vibration loadings: a comparison between pedicle screw fixation system with rigid and flexible rods. J Mater Sci Mater Med 30:118

    Article  Google Scholar 

  24. Oikonomidis S, Ashqar G, Kaulhausen T, Herren C, Siewe J, Sobottke R (2018) Clinical experiences with a PEEK-based dynamic instrumentation device in lumbar spinal surgery: 2 years and no more. J Orthop Surg Res 13:196

    Article  Google Scholar 

  25. Bredow J, Lohrer L, Oppermann J, Scheyerer MJ, Sobottke R, Eysel P et al (2017) Pathoanatomic risk factors for instability and adjacent segment disease in lumbar spine: how to use topping off? Biomed Res Int 2017:2964529

    Article  CAS  Google Scholar 

  26. Fan W, Guo LX (2017) Influence of different frequencies of axial cyclic loading on time-domain vibration response of the lumbar spine: a finite element study. Comput Biol Med 86:75–81

    Article  Google Scholar 

  27. Palepu V, Helgeson MD, Molyneaux-Francis M, Nagaraja S (2019) The effects of bone microstructure on subsidence risk for ALIF, LLIF, PLIF, and TLIF spine cages. J Biomech Eng 141(3):031002

    Article  Google Scholar 

  28. Guo LX, Fan W (2017) The effect of single-level disc degeneration on dynamic response of the whole lumbar spine to vertical vibration. World Neurosurg 105:510–518

    Article  Google Scholar 

  29. Más Y, Gracia L, Ibarz E, Gabarre S, Peña D, Herrera A (2017) Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations. PLoS One 12(11):e0188328

    Article  Google Scholar 

  30. Anasetti F, Galbusera F, Aziz HN, Bellini CM, Addis A, Villa T et al (2010) Spine stability after implantation of an interspinous device: an in vitro and finite element biomechanical study. J Neurosurg Spine 13(5):568–575

    Article  Google Scholar 

  31. Agarwal A, Palepu V, Agarwal AK, Goel VK, Yildirim ED (2013) Biomechanical evaluation of an endplate-conformed polycaprolactone-hydroxyapatite intervertebral fusion graft and its comparison with a typical nonconformed cortical graft. J Biomech Eng 135(6):061005

    Article  Google Scholar 

  32. Guo LX, Yin JY (2019) Finite element analysis and design of an interspinous device using topology optimization. Med Biol Eng Comput 57(1):89–98

    Article  Google Scholar 

  33. Guo LX, Fan W (2019) Impact of material properties of intervertebral disc on dynamic response of the human lumbar spine to vertical vibration: a finite element sensitivity study. Med Biol Eng Comput 57(1):221–229

    Article  Google Scholar 

  34. Chien CY, Kuo YJ, Lin SC, Chuang WH, Luh YP (2014) Kinematic and mechanical comparisons of lumbar hybrid fixation using dynesys and cosmic systems. Spine 39(15):E878–E884

    Article  Google Scholar 

  35. Chuang WH, Lin SC, Chen SH, Wang CW, Tsai WC, Chen YJ et al (2012) Biomechanical effects of disc degeneration and hybrid fixation on the transition and adjacent lumbar segments: trade-off between junctional problem, motion preservation, and load protection. Spine 37(24):E1488–E1497

    Article  Google Scholar 

  36. Mageswaran P, Techy F, Colbrunn RW, Bonner TF, McLain RF (2012) Hybrid dynamic stabilization: a biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine. J Neurosurg Spine 17(3):232–242

    Article  Google Scholar 

  37. Hudson WR, Gee JE, Billys JB, Castellvi AE (2011) Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine. SAS J 5(2):36–43

    Article  Google Scholar 

  38. Faizan A, Kiapour A, Kiapour AM, Goel VK (2014) Biomechanical analysis of various footprints of transforaminal lumbar interbody fusion devices. J Spinal Disord Tech 27(4):E118–E127

    Article  Google Scholar 

  39. Peck JH, Kavlock KD, Showalter BL, Ferrell BM, Peck DG, Dmitriev AE (2018) Mechanical performance of lumbar intervertebral body fusion devices: an analysis of data submitted to the Food and Drug Administration. J Biomech 78:87–93

    Article  Google Scholar 

Download references

Funding

This project is supported by the National Natural Science Foundation of China (Grant No. 52005089, 51875096) and Fundamental Research Funds for the Central Universities (Grant No. N2103010).

Author information

Authors and Affiliations

  1. School of Mechanical Engineering and Automation, Northeastern University, No. 3-11, Wenhua Road, Heping District, Shenyang, 110819, China

    Wei Fan & Li-Xin Guo

Authors
  1. Wei Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Xin Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Fan.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fan, W., Guo, LX. Biomechanical investigation of topping-off technique using an interspinous process device following lumbar interbody fusion under vibration loading. Med Biol Eng Comput 59, 2449–2458 (2021). https://doi.org/10.1007/s11517-021-02458-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11517-021-02458-z

Keywords

Search

Navigation