Comparison of the Susceptibility to Implant Failure in the Lateral, Posterior, and Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis
Comparison of the Susceptibility to Implant Failure in the Lateral, Posterior, and Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis
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DOI：
10.1016/j.wneu.2022.05.056
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发表时间：
2022-08-03
影响因子：
2
通讯作者：
Doita, Minoru
中科院分区：
文献类型：
--
作者：
Oikawa, Ryo;Murakami, Hideki;Doita, Minoru
目的：腰椎椎体间融合术有多种技术，腰椎椎体间融合术后植入物失效可能是个麻烦。本研究旨在比较外侧腰椎椎间融合术（LLIF）、后路腰椎椎间融合术（PLIF）和经椎间孔腰椎椎间融合术（TLIF）中后路植入物和螺钉周围椎体的应力，并选择最不可能导致植入物失效的技术。我们创建了一个完整的L3-L5模型，并使用有限元方法模拟L4-L5的LLIF、PLIF和TLIF技术。固定L5下部的所有模型，并在L3上部施加400 N的预载荷和7.5 Nm的力矩，以模拟屈曲、伸展、侧弯和轴向旋转。我们研究了LLIF、PLIF和TLIF技术的后路植入物和螺钉周围椎体的峰值应力和应力集中。结果：后路植入物以及螺钉周围椎体的伸展、屈曲、弯曲和旋转峰值应力和应力集中在LLIF中最低，其次是PLIF和TLIF。结论：发现LLIF中发生植入物失效的可能性最小，其次是PLIF和TLIF。因此，外科医生在选择适当的手术技术时应了解这些因素，并在术后随访期间小心植入物失效。
OBJECTIVE: There are several techniques for lumbar interbody fusion, and implant failure following lumbar interbody fusion can be troublesome. This study aimed to compare the stress in posterior implant and peri-screw vertebral bodies among lateral lumbar interbody fusion (LLIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) and to select the technique that is least likely to cause implant failure.METHODS: We created an intact L3-L5 model and simulated the LLIF, PLIF, and TLIF techniques at L4-L5 using finite element methods. All models at the lower portion of L5 were fixed and imposed a preload of 400 N and a moment of 7.5 Nm on the upper portion of L3 to simulate flexion, extension, lateral bending, and axial rotation. We investigated the peak stresses and stress concentration in the posterior implant and peri-screw vertebral bodies for the LLIF, PLIF, and TLIF techniques.RESULTS: The extension, flexion, bending, and rotation peak stresses and stress concentration in the posterior implant, as well as the peri-screw vertebral bodies, were the lowest in LLIF, followed by PLIF and TLIF.CONCLUSIONS: It was found that implant failure was least likely to occur in LLIF, followed by PLIF and TLIF. Hence, surgeons should be aware of these factors when selecting an appropriate surgical technique and be careful for implant failure during postoperative follow-up.