Abstract:
STUDY DESIGN:To determine the effect of cage/spacer stiffness on the stresses in the bone graft and cage subsidence. OBJECTIVE:To investigate the effect of cage stiffness on the biomechanics of the fused segment in the lumbar region using finite element analysis. SUMMARY OF BACKGROUND DATA:There are a wide variety of cage/spacer designs available for lumbar interbody fusion surgery. These range from circular, tapered, rectangular with and without curvature, and were initially manufactured using titanium alloy. Recent advances in the medical implant industry have resulted in using medical grade polyetheretherketone (PEEK). The biomechanical advantages of using different cage material in terms of stability, subsidence, and stresses in bone graft are not fully understood. METHODS:A previously validated 3-dimensional, nonlinear finite element model of an intact L3-L5 segment was modified to simulate posterior interbody fusion spacers made of PEEK ("E" = 3.6 GPa) and titanium ("E" = 110 GPa) at the L4/5 disc with posterior instrumentation. Bone graft ("E" = 12 GPa) packed between the spacers in the intervertebral space was also simulated. The posterior lumbar interbody fusion spacer with instrumentation and graft represent a simulation of the condition present immediately after surgery. RESULTS:The peak centroidal Von Mises stresses in the graft bone increased by at least 9-fold with PEEK spacers as compared to titanium spacer. The peak centroidal Von Mises stresses in the endplates increased by at least 2.4-fold with titanium spacers over the PEEK spacers. These stresses were concentrated at places where the spacer interfaced with the endplate. The stiffness of the spacer did not affect the relative motion (stability) across the instrumented (L4/5) segment. CONCLUSIONS:Spacers less stiff than the graft will: (1) provide stability similar to titanium cages in the presence of posterior instrumentation, (2) reduce the stresses in endplates adjacent to the spacers, and (3) increase the load transfer through the graft, as evident from the increase in stresses in graft.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Vadapalli S,Sairyo K,Goel VK,Robon M,Biyani A,Khandha A,Ebraheim NAdoi
10.1097/01.brs.0000250177.84168.basubject
Has Abstractpub_date
2006-12-15 00:00:00pages
E992-8issue
26eissn
0362-2436issn
1528-1159pii
00007632-200612150-00017journal_volume
31pub_type
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