Biomechanical impact analysis of implant positioning in lumbar interbody fusion by the finite element method

Le Duy Nguyen Ho; Thi Hoang Thuy Le; Thuc Tri Dang; Truc Tam Vu; Truong Tich Thien

doi:10.15625/2525-2518/22015

Author affiliations

Authors

Le Duy Nguyen Ho \(^1\) Department of Biomedical Engineering, Faculty of Applied Science, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, Dien Hong ward, Ho Chi Minh City, Viet Nam
\(^3\) Vietnam National University Ho Chi Minh City, Vo Truong Toan street, VNU-HCM Urban Area, Quarter 33, Linh Xuan ward, Ho Chi Minh City, Viet Nam
Thi Hoang Thuy Le \(^1\) Department of Biomedical Engineering, Faculty of Applied Science, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, Dien Hong ward, Ho Chi Minh City, Viet Nam
\(^3\) Vietnam National University Ho Chi Minh City, Vo Truong Toan street, VNU-HCM Urban Area, Quarter 33, Linh Xuan ward, Ho Chi Minh City, Viet Nam
Thuc Tri Dang \(^2\) Department of Engineering Mechanics, Faculty of Applied Science, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, Dien Hong ward, Ho Chi Minh City, Viet Nam
\(^3\) Vietnam National University Ho Chi Minh City, Vo Truong Toan street, VNU-HCM Urban Area, Quarter 33, Linh Xuan ward, Ho Chi Minh City, Viet Nam https://orcid.org/0000-0001-8013-6503
Truc Tam Vu \(^4\) Department of Spinal Surgery B, Hospital for Traumatology and Orthopedics, 929 Tran Hung Dao street, Cho Quan ward, Ho Chi Minh City, Viet Nam https://orcid.org/0009-0009-7234-4287
Truong Tich Thien \(^2\) Department of Engineering Mechanics, Faculty of Applied Science, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, Dien Hong ward, Ho Chi Minh City, Viet Nam
\(^3\) Vietnam National University Ho Chi Minh City, Vo Truong Toan street, VNU-HCM Urban Area, Quarter 33, Linh Xuan ward, Ho Chi Minh City, Viet Nam https://orcid.org/0000-0002-3371-8890

DOI:

https://doi.org/10.15625/2525-2518/22015

Keywords:

finite element model, transforaminal lumbar interbody fusion, biomechanical stability, cage positioning

Abstract

Transforaminal Lumbar Interbody Fusion (TLIF) is a fusion technique in spinal surgeries reserved for chronic conditions requiring stabilization e.g. lumbar spinal stenosis and spondylolisthesis, especially when conservative treatments fail. The procedure involves removing the pathological disc material and putting a spacer with morselized bone graft in the disc space via the transforaminal pathway in order to promote interbody bony fusion. The whole construction is stabilized posteriorly by pedicle screw fixation. However, the conventional TLIF technique possessed several drawbacks including cage subsidence and cage protrusion, due to the posterior position of the cage within the disc space and modifications have been proposed in the effort to reduce the mentioned problems. Selecting pedicle screw length is also a topic to debate, when no clear consensus has been established regarding that matter. Therefore, this study uses Finite Element (FE) model under physiological axial compression to investigate the screw length and cage positioning effects on the bone and instruments. This model accounts for the structural interactions between the cage, pedicle screws, and surrounding bone tissue. Our findings highlight the novel insight that anterior cage placement reduces the risk of cage subsidence and improves load distribution. Additionally, the study demonstrates that screw tips should extend beyond the center of the cage to enhance load transfer efficiency and reduce stress on the fixation system.

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