• Zhenjun Zhang, Guy R Fogel, Zhenhua Liao, Yitao Sun, and Weiqiang Liu.
• Department of Mechanical Engineering, Tsinghua University, Beijing, China; Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen, China.
• World Neurosurg. 2018 Jun 1; 114: e1120-e1129.

BackgroundLateral lumbar interbody fusion using cage supplemented with fixation has been used widely in the treatment of lumbar disease. A combined fixation (CF) of lateral plate and spinous process plate may provide multiplanar stability similar to that of bilateral pedicle screws (BPS) and may reduce morbidity. The biomechanical influence of the CF on cage subsidence and facet joint stress has not been well described. The aim of this study was to compare biomechanics of various fixation options and to verify biomechanical effects of the CF.MethodsThe surgical finite element models with various fixation options were constructed based on computed tomography images. The lateral plate and posterior spinous process plate were applied (CF). The 6 motion modes were simulated. Range of motion (ROM), cage stress, endplate stress, and facet joint stress were compared.ResultsFor the CF model, ROM, cage stress, and endplate stress were the minimum in almost all motion modes. Compared with BPS, the CF reduced ROM, cage stress, and endplate stress in all motion modes. The ROM was reduced by more than 10% in all motion modes except for flexion; cage stress and endplate stress were reduced more than 10% in all motion modes except for rotation-left. After interbody fusion, facet joint stress was reduced substantially compared with the intact conditions in all motion modes except for flexion.ConclusionsThe combined plate fixation may offer an alternative to BPS fixation in lateral lumbar interbody fusion.Copyright © 2018 Elsevier Inc. All rights reserved.

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