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Biomechanical properties of lumbar vertebral ring apophysis cage under endplate injury: a finite element analysis – Lumbar Fusion

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The article presents a study comparing the biomechanical properties of lumbar interbody fusion using two different types of cages. The study aimed to evaluate the effectiveness of a cage spanning the ring apophysis, regardless of the endplate’s integrity. A finite element model of the normal spine was used to simulate the fusion procedures. The analysis included range of motion, stress on the screw-rod system, interface stress between the cage and endplate, and intervertebral disc pressure. The results showed that a long cage spanning the ring apophysis provided greater support strength compared to a short cage. The study highlights the importance of maintaining the endplate’s integrity during surgery and suggests using a cage that exceeds the width of the pedicle by at least 5 mm to prevent complications

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established sugical centre in UK

Published article

CONCLUSIONS: Caution should be exercised during endplate preparation and cage placement to maintain the endplate’s integrity. Based on preoperative X-ray evaluation, the selection of a cage that exceeds the width of the pedicle by at least 5 mm (ensuring complete coverage of the vertebral ring) has demonstrated remarkable biomechanical performance in lateral lumbar interbody fusion procedures. By opting for such a cage, we expect a reduced occurrence of complications, including cage subsidence,…

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
BMC Musculoskelet Disord. 2023 Aug 30;24(1):695. doi: 10.1186/s12891-023-06792-1.ABSTRACTOBJECTIVE: This study aimed to compare the biomechanical properties of lumbar interbody fusion involving two types of cages. The study evaluated the effectiveness of the cage spanning the ring apophysis, regardless of the endplate’s integrity.METHODS: A finite element model of the normal spine was established and validated in,

BMC Musculoskelet Disord. 2023 Aug 30;24(1):695. doi: 10.1186/s12891-023-06792-1.

ABSTRACT

OBJECTIVE: This study aimed to compare the biomechanical properties of lumbar interbody fusion involving two types of cages. The study evaluated the effectiveness of the cage spanning the ring apophysis, regardless of the endplate’s integrity.

METHODS: A finite element model of the normal spine was established and validated in this study. The validated model was then utilized to simulate Lateral Lumbar Interbody Fusion (LLIF) with posterior pedicle screw fixation without posterior osteotomy. Two models of interbody fusion cage were placed at the L4/5 level, and the destruction of the bony endplate caused by curetting the cartilaginous endplate during surgery was simulated. Four models were established, including Model 1 with an intact endplate and long cage spanning the ring apophysis, Model 2 with endplate decortication and long cage spanning the ring apophysis, Model 3 with an intact endplate and short cage, and Model 4 with endplate decortication and short cage. Analyzed were the ROM of the fixed and adjacent segments, screw rod system stress, interface stress between cage and L5 endplate, trabecular bone stress on the upper surface of L5, and intervertebral disc pressure (IDP) of adjacent segments.

RESULTS: There were no significant differences in ROM and IDP between adjacent segments in each postoperative model. In the short cage model, the range of motion (ROM), contact pressure between the cage and endplate, stress in L5 cancellous bone, and stress in the screw-rod system all exhibited an increase ranging from 0.4% to 79.9%, 252.9% to 526.9%, 27.3% to 133.3%, and 11.4% to 107%, respectively. This trend was further amplified when the endplate was damaged, resulting in a maximum increase of 88.6%, 676.1%, 516.6%, and 109.3%, respectively. Regardless of the integrity of the endplate, the long cage provided greater support strength compared to the short cage.

CONCLUSIONS: Caution should be exercised during endplate preparation and cage placement to maintain the endplate’s integrity. Based on preoperative X-ray evaluation, the selection of a cage that exceeds the width of the pedicle by at least 5 mm (ensuring complete coverage of the vertebral ring) has demonstrated remarkable biomechanical performance in lateral lumbar interbody fusion procedures. By opting for such a cage, we expect a reduced occurrence of complications, including cage subsidence, internal fixation system failure, and rod fracture.

PMID:37649054 | DOI:10.1186/s12891-023-06792-1

The London Spine Unit : most established sugical centre in UK

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Biomechanical properties of lumbar vertebral ring apophysis cage under endplate injury: a finite element analysis

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BMC Musculoskelet Disord. 2023 Aug 30;24(1):695. doi: 10.1186/s12891-023-06792-1.ABSTRACTOBJECTIVE: This study aimed to compare the biomechanical properties of lumbar interbody fusion involving two types of cages. The study evaluated the effectiveness of the cage spanning the ring apophysis, regardless of the endplate's integrity.METHODS: A finite element model of the normal spine was established and validated in

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