Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc

Surgical treatments for lower back pain can be distributed into two main groups: fusion (arthrodesis) and disc replacement (arthroplasty). The objective of this study was to compare, under severe loading conditions, the biomechanics of the lumbar spine treated either by fusion or total disc replacement (TDR). A three-dimensional model of a two-level ligamentous lumbar segment was created and simulated through static analyses with the finite-element method (FEM) software ABAQUS. The model was validated by comparing mobility, pressure on the facets, force in the ligaments, maximum stresses, disc bulge, and endplate deflection with measured data given in the literature. The FEM analysis predicted that the mobility of the model after arthrodesis on the upper level was reduced in all rotational degrees of freedom by an average of approximately 44%, relative to healthy normal discs. Conversely, the mobility of the model after TDR on the upper level was increased in all rotational degrees of freedom by an average of approximately 52%. The level implanted with the artificial disc showed excessive ligament tensions (greater than 500 N), high facet pressures (greater than 3 MPa), and a high risk of instability. The mobility and the stresses in the level adjacent to the arthroplasty were also increased. In conclusion, the model for an implanted movable artificial disc illustrated complications common to spinal arthroplasty and showed greater risk of instability and further degeneration than predicted for the fused model. This modeling technique provides an accurate means for assessing potential biomechanical risks and can be used to improve the design of future artificial intervertebral discs. (c) 2005 Elsevier Ltd. All rights reserved.