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Impact of osteoporosis and Cement-Augmented fusion on adjacent spinal levels Post-Fusion Surgery: Patient-Specific finite element analysis – Lumbar Fusion

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The article discusses the use of cement-augmentation in posterior lumbar instrumented fusion (PLIF) surgeries to strengthen compromised osteoporotic vertebral bone and improve surgical outcomes. A novel segmented vertebral body regional modeling approach was used to study the effects of osteoporosis and cement-augmented fusion on disc biomechanics at adjacent spinal levels. The study found that while osteoporosis did not significantly affect the post-surgery characteristics of adjacent intervertebral discs (IVDs), cement-augmentation increased the risk of adjacent segment disease (ASD) incidence. The research highlights the importance of understanding the complex interplay between structural reinforcement techniques, such as cement augmentation, and altered biomechanics for long-term patient outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

Cement-augmentation is a technique commonly used during posterior lumbar instrumented fusion (PLIF) to reinforce compromised osteoporotic vertebral bone, minimize the risk of loosening screws, enhance stability, and improve overall surgical outcomes. In this study, we introduce a novel segmented vertebral body regional modeling approach to investigate the effects of osteoporosis and cement-augmented lumbar fusion on disc biomechanics at spinal levels adjacent to the fused vertebrae. Using our…

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J Biomech. 2024 Mar 30;166:112070. doi: 10.1016/j.jbiomech.2024.112070. Online ahead of print. ABSTRACT Cement-augmentation is a technique commonly used during posterior lumbar instrumented fusion (PLIF) to reinforce compromised osteoporotic vertebral bone, minimize the risk of loosening screws, enhance stability, and improve overall surgical outcomes. In this study, we introduce a novel segmented vertebral body regional modeling,

J Biomech. 2024 Mar 30;166:112070. doi: 10.1016/j.jbiomech.2024.112070. Online ahead of print.

ABSTRACT

Cement-augmentation is a technique commonly used during posterior lumbar instrumented fusion (PLIF) to reinforce compromised osteoporotic vertebral bone, minimize the risk of loosening screws, enhance stability, and improve overall surgical outcomes. In this study, we introduce a novel segmented vertebral body regional modeling approach to investigate the effects of osteoporosis and cement-augmented lumbar fusion on disc biomechanics at spinal levels adjacent to the fused vertebrae. Using our previously validated personalized-poroelastic-osteoligamentous FE model of the spine, fusion was simulated at L4-L5, and the biomechanics of adjacent levels were studied for 30 patients (non-osteoporotic patients (N = 15), osteoporotic patients (N = 15)). PLIF models, with and without cement-augmentation, were developed and compared after an 8 h-rest period (200 N), following a 16 h-cyclic compressive loading of 500-1000 N (40 and 20 min, respectively). Movement in different directions (flexion/ extension/ lateral bending/ axial rotation) was simulated using 10Nm moment before and after cyclic loading. The material mapping algorithm was validated by comparing the results of voxel-based and parametric models. The FE cement-augmented models, subject to daily activity loading, demonstrated significant differences in disc height loss and fluid loss as compared to non-cemented models. The calculated axial stress and fiber strain values were also significantly higher for these models. This work demonstrates that although osteoporosis does not significantly alter the time-dependent characteristics of adjacent IVDs post-surgery, cement-augmentation increases the risk of adjacent segment disease (ASD) incidence. A holistic understanding of the trade-offs and long-term complex interplay between structural reinforcement modalities, including cement augmentation, and altered biomechanics warrants further investigation.

PMID:38569456 | DOI:10.1016/j.jbiomech.2024.112070

The London Spine Unit : innovative sugical centre in the world

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Impact of osteoporosis and Cement-Augmented fusion on adjacent spinal levels Post-Fusion Surgery: Patient-Specific finite element analysis

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J Biomech. 2024 Mar 30;166:112070. doi: 10.1016/j.jbiomech.2024.112070. Online ahead of print. ABSTRACT Cement-augmentation is a technique commonly used during posterior lumbar instrumented fusion (PLIF) to reinforce compromised osteoporotic vertebral bone, minimize the risk of loosening screws, enhance stability, and improve overall surgical outcomes. In this study, we introduce a novel segmented vertebral body regional modeling

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