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Finite Element Based-Analysis for Pre and Post Lumbar Fusion of Adult Degenerative Scoliosis Patients

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Abstract

Study Design

Pre-post cohort finite elements (FE).

Objectives

To investigate the effect of adjacent load transfer pre and post fusion surgery of lumbar scoliotic spines using FE models.

Summary of Background Data

Adult degenerative scoliosis (ADS) results from age-related changes, leading to segmental instability, deformity, and stenosis. FE study is capable of capturing the biomechanical parameters internal to the bones and connective soft tissues of the spine, which is difficult to measure by experimental approaches. Literature that describes the underlying mechanisms responsible for spinal fusion in scoliosis patients is limited, and FE study with larger subject sample size should be conducted.

Methods

Twenty three-dimensional nonlinear FE models of the lumbosacral spine were created from pre (Cobb angle: 28.1° ± 10.5°) and post scoliosis surgery in vivo CT scans. During surgery, pedicle screws and rods were implanted at lumbar and sacral levels. A compressive load and six different moments (flexion, extension, right lateral bending, left lateral bending, right axial rotation, left axial rotation) were applied to the top level of each model. Outcome measures were range of motion (RoM), intradiscal pressure (IDP), and facet joint forces (FJF). Spinal fusion did alter the mechanical function of the scoliotic spine.

Results

Scoliotic spine presented abnormal and asymmetrical kinetic and kinematic behavior. RoM: At the adjacent level, spinal fusion surgery produced a statically significantly increased left and right later bending intersegmental rotation (p < .006) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced a statically significantly reduced intersegmental rotation in all the loading conditions (p = .001) in comparison to presurgical scoliosis models. IDP: At the fused level, spinal fusion surgery produced a much lower IDP in all of the loading conditions (p = .001). FJF: At the adjacent level, spinal fusion surgery produced a considerably larger left lateral rotation FJF (p = .001) in comparison to presurgical scoliosis models. At the fused level, spinal fusion surgery produced considerably lower FJF in all the loading conditions (p = .001) in comparison to presurgical scoliosis models.

Conclusions

This study was the first to investigate the effect of adjacent load transfer before and after fusion surgery using in vivo CT scans of 10 scoliotic spines. A posterior fusion has only a minor effect on mechanical behavior and a large effect on pressure and forces at the adjacent level. As expected, a large effect in the kinematics and kinetics was found at the fused level.

Level of Evidence

Level 3.

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Author information

Authors and Affiliations

  1. Texas Back Institute Research Foundation, 6020 West Parker Road No. 200, Plano, TX, 75093, USA

    Ram Haddas PhD

  2. Mechanical Engineering, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409, USA

    Ming Xu MEng & James Yang PhD

  3. Texas Back Institute, 6020 West Parker Road No. 200, Plano, TX, 75093, USA

    Isador Lieberman MD

Authors
  1. Ram Haddas PhD
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  2. Ming Xu MEng
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  3. Isador Lieberman MD
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  4. James Yang PhD
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Corresponding author

Correspondence to Ram Haddas PhD.

Additional information

Author disclosures: RH (grants from Cervical Spine Research Society, United States, grants from Alphatec Spine Inc., United States, grants from Aspen Brace Inc., United States, grant from SI-Bone Inc., United States, outside the submitted work), MX (none), IL (personal fees and other from Mazor Robotics; other from Bionik Laboratories; personal fees from Safe Orthopaedics, Globus Spine, Misonix, Medtronic, and SIBone; other from Stryker, outside the submitted work), JY (none).

Funding: None.

IRB approval: Not applicable.

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Haddas, R., Xu, M., Lieberman, I. et al. Finite Element Based-Analysis for Pre and Post Lumbar Fusion of Adult Degenerative Scoliosis Patients. Spine Deform 7, 543–552 (2019). https://doi.org/10.1016/j.jspd.2018.11.008

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  • DOI: https://doi.org/10.1016/j.jspd.2018.11.008

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