Differences in 3D vs. 2D analysis in lumbar spinal fusion simulations |
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| Institution: | 1. Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany;2. Spine Department, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany;1. Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China;2. Department of Medical Ultrasonics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China;3. Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China;1. Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;3. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;1. School of Basic Medical Sciences, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, 510515, China;2. Dept of Spinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang West Road, Guangzhou, Guangdong, 510120, China;3. MOE Key Laboratory of Disaster Forecast and Control in Engineering, Institute of Applied Mechanics, Jinan University, Guangzhou, Guangdong, 510632, China;4. School of Mechanical and Electrical Engineering, Putian University, Putian, Fujian, China;1. Department of Neurosurgery, King Edward Memorial Hospital and Seth G. S. Medical College, Parel, Mumbai, India;2. Lilavati Hospital and Research Centre, Bandra, Mumbai, India |
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| Abstract: | Lumbar interbody fusion is currently the gold standard in treating patients with disc degeneration or segmental instability. Despite it having been used for several decades, the non-union rate remains high. A failed fusion is frequently attributed to an inadequate mechanical environment after instrumentation. Finite element (FE) models can provide insights into the mechanics of the fusion process. Previous fusion simulations using FE models showed that the geometries and material of the cage can greatly influence the fusion outcome. However, these studies used axisymmetric models which lacked realistic spinal geometries. Therefore, different modeling approaches were evaluated to understand the bone-formation process.Three FE models of the lumbar motion segment (L4–L5) were developed: 2D, Sym-3D and Nonsym-3D. The fusion process based on existing mechano-regulation algorithms using the FE simulations to evaluate the mechanical environment was then integrated into these models. In addition, the influence of different lordotic angles (5, 10 and 15°) was investigated. The volume of newly formed bone, the axial stiffness of the whole segment and bone distribution inside and surrounding the cage were evaluated.In contrast to the Nonsym-3D, the 2D and Sym-3D models predicted excessive bone formation prior to bridging (peak values with 36 and 9% higher than in equilibrium, respectively). The 3D models predicted a more uniform bone distribution compared to the 2D model.The current results demonstrate the crucial role of the realistic 3D geometry of the lumbar motion segment in predicting bone formation after lumbar spinal fusion. |
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| Keywords: | Finite element method Lumbar spinal fusion Bone formation Interbody cages Lordotic curve |
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