Anatomical parameters alter the biomechanical responses of adjacent segments following lumbar fusion surgery: Personalized poroelastic finite element modelling investigations

Frontiers in Bioengineering and Biotechnology

Bioengineering and Biotechnology

Meng-Ling Lu¹  Chi-Chien Niu²  Wen-Chien Chen³  Chen-Ju Fu⁴  Hen-Yu Lien⁵  Chih-Hsiu Cheng⁶  Mohammad Nikkhoo⁷ 

[1] Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan;Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan;Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan;Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;Division of Emergency and Critical Care Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan;School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan;School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan;Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran;

关键词: personalized modeling;    finite element analysis;    posterior lumbar fusion;    adjacent segment disease;    spine biomechanics;   

DOI  :  10.3389/fbioe.2023.1110752

 received in 2022-11-29, accepted in 2023-01-30,  发布年份 2023

来源: Frontiers

【 摘 要 】

Introduction: While the short-term post-operative outcome of lumbar fusion is satisfying for most patients, adjacent segment disease (ASD) can be prevalent in long-term clinical observations. It might be valuable to investigate if inherent geometrical differences among patients can significantly alter the biomechanics of adjacent levels post-surgery. This study aimed to utilize a validated geometrically personalized poroelastic finite element (FE) modeling technique to evaluate the alteration of biomechanical response in adjacent segments post-fusion.Methods: Thirty patients were categorized for evaluation in this study into two distinct groups [i.e., 1) non-ASD and 2) ASD patients] based on other long-term clinical follow-up investigations. To evaluate the time-dependent responses of the models subjected to cyclic loading, a daily cyclic loading scenario was applied to the FE models. Different rotational movements in different planes were superimposed using a 10 Nm moment after daily loading to compare the rotational motions with those at the beginning of cyclic loading. The biomechanical responses of the lumbosacral FE spine models in both groups were analyzed and compared before and after daily loading.Results: The achieved comparative errors between the FE results and clinical images were on average below 20% and 25% for pre-op and post-op models, respectively, which confirms the applicability of this predictive algorithm for rough pre-planning estimations. The results showed that the disc height loss and fluid loss were increased for the adjacent discs in post-op models after 16 h of cyclic loading. In addition, significant differences in disc height loss and fluid loss were observed between the patients who were in the non-ASD and ASD groups. Similarly, the increased stress and fiber strain in the annulus fibrosus (AF) was higher in the adjacent level of post-op models. However, the calculated stress and fiber strain values were significantly higher for patients with ASD.Discussion: Evaluating the biomechanical response of pre-op and post-op modeling in the non-ASD and ASD groups showed that the inherent geometric differences among patients cause significant variations in the estimated mechanical response. In conclusion, the results of the current study highlighted the effect of geometrical parameters (which may refer to the anatomical conditions or the induced modifications regarding surgical techniques) on time-dependent responses of lumbar spine biomechanics.

【 授权许可】

Unknown   
Copyright © 2023 Nikkhoo, Chen, Lu, Fu, Niu, Lien and Cheng.