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Biomechanical analysis of lumbar interbody fusion supplemented with various posterior stabilization systems

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Abstract

Purpose

Biomechanical comparison between rigid and non-rigid posterior stabilization systems following lumbar interbody fusion has been conducted in several studies. However, most of these previous studies mainly focused on investigating biomechanics of adjacent spinal segments or spine stability. The objective of the present study was to compare biomechanical responses of the fusion devices when using different posterior instrumentations.

Methods

Finite-element model of the intact human lumbar spine (L1–sacrum) was modified to simulate implantation of the fusion cage at L4–L5 level supplemented with different posterior stabilization systems including (i) pedicle screw-based fixation using rigid connecting rods (titanium rods), (ii) pedicle screw-based fixation using flexible connecting rods (PEEK rods) and (iii) dynamic interspinous spacer (DIAM). Stress responses were compared among these various models under bending moments.

Results

The highest and lowest stresses in endplate, fusion cage and bone graft were found at the fused L4–L5 level with DIAM and titanium rod stabilization systems, respectively. When using PEEK rod for the pedicle screw fixation, peak stress in the pedicle screw was lower but the ratio of peak stress in the rods to yield stress of the rod material was higher than using titanium rod.

Conclusions

Compared with conventional rigid posterior stabilization system, the use of non-rigid stabilization system (i.e., the PEEK rod system and DIAM system) following lumbar interbody fusion might increase the risks of cage subsidence and cage damage, but promote bony fusion due to higher stress in the bone graft. For the pedicle screw-based rod stabilization system, using PEEK rod might reduce the risk of screw breakage but increased breakage risk of the rod itself.

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Acknowledgements

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

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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

  2. Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China

    Ming Zhang

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Correspondence to Wei Fan.

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Fan, W., Guo, LX. & Zhang, M. Biomechanical analysis of lumbar interbody fusion supplemented with various posterior stabilization systems. Eur Spine J 30, 2342–2350 (2021). https://doi.org/10.1007/s00586-021-06856-7

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  • DOI: https://doi.org/10.1007/s00586-021-06856-7

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