• World Neurosurg · Jun 2020

    Stability evaluation of oblique lumbar interbody fusion constructs with various fixation options: A finite element analysis based on three-dimensional scanning models.

    • Hui-Zhi Guo, Yong-Chao Tang, Dan-Qing Guo, Pei-Jie Luo, Yong-Xian Li, Guo-Ye Mo, Yan-Huai Ma, Jian-Cheng Peng, LiangDeDepartment of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China., and Shun-Cong Zhang.
    • First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China; Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
    • World Neurosurg. 2020 Jun 1; 138: e530-e538.

    BackgroundLittle is known about the biomechanical performance of various fixation constructs after oblique lumbar interbody fusion (OLIF). This study aimed to explore the stability of various fixation options for OLIF by using finite element analysis based on three-dimensional scanning models.MethodsSix validated finite element models of the L3-L5 segment were reconstructed via computed tomography images, including (1) intact model, (2) stand-alone model with no instrument, (3) lateral rod-screw model, (4) lateral rod-screw plus contralateral translaminar facet screw (LRS-CTLFS) model, (5) unilateral pedicle screw model, and (6) bilateral pedicle screw (BPS) model. Models of the OLIF cage and pedicle screw were created with three-dimensional scanning to improve the accuracy of finite element analysis. Range of motion, stress of the cage, and stress of fixation were evaluated in the different models.ResultsRange of motion increased from least to greatest as follows: BPS, LRS-CTLFS, unilateral pedicle screw, lateral rod-screw, stand-alone. Differences in range of motion between BPS and LRS-CTLFS were not significant for all loading cases. Compared with the other 3 models, the stress of the cage was found to be lower in BPS and LRS-CTLFS under all loading conditions, especially in BPS. Stress exerted on the fixation was the greatest in LRS-CTLFS, and the stress experienced by the translaminar facet screw was concentrated in part of the facet joint.ConclusionsThe BPS model provided the best biomechanical stability for OLIF; the stand-alone model could not provide sufficient stability. The LRS-CTLFS procedure increases the approximate stability and reduces stress at the cage-endplate interface; however, it causes an increase in screw stress.Copyright © 2020 Elsevier Inc. All rights reserved.

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