Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study
Abstract Background Cage subsidence causes poor prognoses in patients treated by oblique lumbar interbody fusion (OLIF). Deterioration of the biomechanical environment initially triggers cage subsidence, and patients with low bone mineral density (BMD) suffer a higher risk of cage subsidence. Howeve...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-022-06049-3 |
| _version_ | 1798005333035057152 |
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| author | Zhi-Qiang Yang Ping Cai Jing-Chi Li Xian-Di Wang Tian-Hang Xie Xing-Xiao Pu Run Lin Jian-Cheng Zeng Yue-Ming Song |
| author_facet | Zhi-Qiang Yang Ping Cai Jing-Chi Li Xian-Di Wang Tian-Hang Xie Xing-Xiao Pu Run Lin Jian-Cheng Zeng Yue-Ming Song |
| author_sort | Zhi-Qiang Yang |
| collection | DOAJ |
| description | Abstract Background Cage subsidence causes poor prognoses in patients treated by oblique lumbar interbody fusion (OLIF). Deterioration of the biomechanical environment initially triggers cage subsidence, and patients with low bone mineral density (BMD) suffer a higher risk of cage subsidence. However, whether low BMD increases the risk of cage subsidence by deteriorating the local biomechanical environment has not been clearly identified. Methods OLIF without additional fixation (stand-alone, S-A) and with different additional fixation devices (AFDs), including anterolateral single rod screws (ALSRs) and bilateral pedicle screws (BPSs) fixation, was simulated in the L4-L5 segment of a well-validated finite element model. The biomechanical effects of different BMDs were investigated by adjusting the material properties of bony structures. Biomechanical indicators related to cage subsidence were computed and recorded under different directional moments. Results Overall, low BMD triggers stress concentration in surgical segment, the highest equivalent stress can be observed in osteoporosis models under most loading conditions. Compared with the flexion-extension loading condition, this variation tendency was more pronounced under bending and rotation loading conditions. In addition, AFDs obviously reduced the stress concentration on both bony endplates and the OLIF cage, and the maximum stress on ALSRs was evidently higher than that on BPSs under almost all loading conditions. Conclusions Stepwise reduction of BMD increases the risk of a poor local biomechanical environment in OLIF patients, and regular anti-osteoporosis therapy should be considered an effective method to biomechanically optimize the prognosis of OLIF patients. |
| first_indexed | 2024-04-11T12:37:27Z |
| format | Article |
| id | doaj.art-24d616974f91469899906d6995bec63e |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T12:37:27Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-24d616974f91469899906d6995bec63e2022-12-22T04:23:35ZengBMCBMC Musculoskeletal Disorders1471-24742022-12-0123111310.1186/s12891-022-06049-3Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico studyZhi-Qiang Yang0Ping Cai1Jing-Chi Li2Xian-Di Wang3Tian-Hang Xie4Xing-Xiao Pu5Run Lin6Jian-Cheng Zeng7Yue-Ming Song8Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedics, Affiliated Hospital of Nanjing University of Chinese MedicineDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityDepartment of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan UniversityAbstract Background Cage subsidence causes poor prognoses in patients treated by oblique lumbar interbody fusion (OLIF). Deterioration of the biomechanical environment initially triggers cage subsidence, and patients with low bone mineral density (BMD) suffer a higher risk of cage subsidence. However, whether low BMD increases the risk of cage subsidence by deteriorating the local biomechanical environment has not been clearly identified. Methods OLIF without additional fixation (stand-alone, S-A) and with different additional fixation devices (AFDs), including anterolateral single rod screws (ALSRs) and bilateral pedicle screws (BPSs) fixation, was simulated in the L4-L5 segment of a well-validated finite element model. The biomechanical effects of different BMDs were investigated by adjusting the material properties of bony structures. Biomechanical indicators related to cage subsidence were computed and recorded under different directional moments. Results Overall, low BMD triggers stress concentration in surgical segment, the highest equivalent stress can be observed in osteoporosis models under most loading conditions. Compared with the flexion-extension loading condition, this variation tendency was more pronounced under bending and rotation loading conditions. In addition, AFDs obviously reduced the stress concentration on both bony endplates and the OLIF cage, and the maximum stress on ALSRs was evidently higher than that on BPSs under almost all loading conditions. Conclusions Stepwise reduction of BMD increases the risk of a poor local biomechanical environment in OLIF patients, and regular anti-osteoporosis therapy should be considered an effective method to biomechanically optimize the prognosis of OLIF patients.https://doi.org/10.1186/s12891-022-06049-3Oblique lumbar interbody fusionBone mineral densityCage subsidenceBiomechanicsFinite element analysis |
| spellingShingle | Zhi-Qiang Yang Ping Cai Jing-Chi Li Xian-Di Wang Tian-Hang Xie Xing-Xiao Pu Run Lin Jian-Cheng Zeng Yue-Ming Song Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study BMC Musculoskeletal Disorders Oblique lumbar interbody fusion Bone mineral density Cage subsidence Biomechanics Finite element analysis |
| title | Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study |
| title_full | Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study |
| title_fullStr | Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study |
| title_full_unstemmed | Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study |
| title_short | Stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically: an in-silico study |
| title_sort | stepwise reduction of bone mineral density increases the risk of cage subsidence in oblique lumbar interbody fusion patients biomechanically an in silico study |
| topic | Oblique lumbar interbody fusion Bone mineral density Cage subsidence Biomechanics Finite element analysis |
| url | https://doi.org/10.1186/s12891-022-06049-3 |
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