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Computational comparison of bone cement and poly aryl-ether-ether-ketone spacer in single-segment posterior lumbar interbody fusion: a pilot study

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Abstract

Posterior lumbar interbody fusion (PLIF) with a spacer and posterior instrument (PI) via minimally invasive surgery (MIS) restores intervertebral height in degenerated disks. To align with MIS, the spacer has to be shaped with a slim geometry. However, the thin spacer increases the subsidence and migration after PLIF. This study aimed to propose a new lumbar fusion approach using bone cement to achieve a larger supporting area than that achieved by the currently used poly aryl-ether-ether-ketone (PEEK) spacer and assess the feasibility of this approach using a sawbone model. Furthermore, the mechanical responses, including the range of motion (ROM) and bone stress with the bone cement spacer were compared to those noted with the PEEK spacer by finite element (FE) simulation. An FE lumbar L3–L4 model with PEEK and bone cement spacers and PI was developed. Four fixing conditions were considered: intact lumbar L3–L4 segment, lumbar L3–L4 segment with PI, PEEK spacer plus PI, and bone cement spacer plus PI. Four kinds of 10-NM moments (flexion, extension, lateral bending, and rotation) and two different bone qualities (normal and osteoporotic) were considered. The bone cement spacer yielded smaller ROMs in extension and rotation than the PEEK spacer, while the ROMs of the bone cement spacer in flexion and lateral bending were slightly greater than with the PEEK spacer. Compared with the PEEK spacer, peak contact pressure on the superior surface of L4 with the bone cement spacer in rotation decreased by 74% (from 8.68 to 2.25 MPa) and 69.1% (from 9.1 to 2.82 MPa), respectively, in the normal and osteoporotic bone. Use of bone cement as a spacer with PI is a potential approach to decrease the bone stress in lumbar fusion and warrants further research.

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Acknowledgements

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by National Cheng Kung University—Show Chwan Health Care System R&D Project (NCKUSCMH10612).

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Author notes

  1. Chih-Wei Chang and Yu-Hsuan Chung contributed equally to this study.

Authors and Affiliations

  1. Department of BioMedical Engineering, National Cheng Kung University, Tainan, Taiwan

    Chih-Wei Chang, Chia-Jung Chang, Chih-Han Chang & Yao-Te Peng

  2. Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chih-Wei Chang

  3. Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chih-Wei Chang

  4. Department of Orthopedics, Show Chwan Memorial Hospital, Changhua City, Taiwan

    Yu-Hsuan Chung

  5. Department of Physical Therapy, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan

    Yen-Nien Chen

  6. Institute of Geriatric Welfare Technology & Science, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 25245, Taiwan

    Chun-Ting Li

  7. Metal Industries Research & Development Centre, Kaohsiung City, Taiwan

    Yao-Te Peng

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Chang, CW., Chung, YH., Chang, CJ. et al. Computational comparison of bone cement and poly aryl-ether-ether-ketone spacer in single-segment posterior lumbar interbody fusion: a pilot study. Phys Eng Sci Med 43, 163–173 (2020). https://doi.org/10.1007/s13246-019-00832-8

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