期刊
ORTHOPAEDIC SURGERY
卷 -, 期 -, 页码 -出版社
WILEY
DOI: 10.1111/os.13866
关键词
Adjacent segment degeneration; Biomechanical; Finite element; Lumbar spine; Revision surgery
类别
The study compared the biomechanical effects of different surgical approaches for the treatment of adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF). The results showed that ALIF and LLIF surgeries had similar effects on adjacent segment range of motion (ROM) and intradiscal pressure (IDP), while TLIF surgery had greater effects on adjacent segment ROM and IDP. The stress in cages was highest in the TLIF revision model, indicating stress concentration due to direct extension of the surgical segment in the same direction.
Background and objective: Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Revision surgery is necessary for symptomatic ASD to further decompress and fix the affected segment. However, no optimal construct is accepted as a standard in treating ASD. The purpose of this study was to compare the biomechanical effects of different surgical approaches for the treatment of ASD after primary transforaminal lumbar interbody fusion (TLIF). Methods: A finite element model of the L1-S1 was conducted based on computed tomography scan images. The primary surgery model was developed with a single-level TLIF at L4-L5 segment. The revision surgical models were developed with anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), or TLIF at L3-L4 segment. The range of motion (ROM), intradiscal pressure (IDP), and the stress in cages were compared to investigate the biomechanical influences of different surgical approaches. Results: The results indicated that all the three surgical approaches can stabilize the spinal segment by reducing the ROM at revision level. The ROM and IDP at adjacent segments of revision model of TLIF was greater than those of other revision models. While revision surgery with ALIF and LLIF had similar effects on the ROM and IDP of adjacent segments. Compared among all the surgical models, cage stress in revision model of TLIF was the maximum in extension and axial rotation. Conclusion: The IDP at adjacent segments and stress in cages of revision model of TLIF was greater than those of ALIF and LLIF. This may be that direct extension of the surgical segment in the same direction results in stress concentration.
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