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Effect of Cage Insertion Orientation on Stress Profiles and Subsidence Phenomenon in Posterior Lumbar Interbody Fusion

Muhammad Hazli Mazlan 1, Mitsugu Todo 2, and Hiromitsu Takano 3, and Ikuho Yonezawa 3
1. Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Japan
Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia, Malaysia
2. Research Institute for Applied Mechanics, Kyushu University, Japan
3. Department of Orthopedic Surgery, Juntendo University, School of Medicine, Japan
Abstract—Posterior lumbar interbody fusion has been widely accepted as one of the surgical procedure to treat clinical problems. However, vertebral endplate subsidence failure has been detected as one of its major problems that might increase the potential of pain and mechanical instability. Therefore, posterior instrumentation (PI) has been introduced alongside with double fusion cages implant to limit segmental movement and to facilitate fusion. Nevertheless, the use of two interbody fusion cages will be likely to incur higher cost and more risky. Hence, single oblique cage insertion surgical procedure has been reported as one of the reliable solution. In the present study, an image-based finite element analysis was used to evaluate a subsidence phenomenon based on the fracture risks evaluation and the stress profiles at cage-endplate interface in two different cage insertion orientations namely as double cages and single oblique cage. Apparently, the single oblique inserted cage with PI has significantly produced lower stress than the double inserted cages at the cage-endplate interfaces. At higher impact loading (2000N), the total number of compressive deformations of the double cages outnumbered the single oblique cage at the cage-endplate interface junctions and the deformations were more uniformly distributed. Obviously, there was a trade-off between the stress generation, the implant stability and the risk of vertebral bone failures. The single oblique cage insertion method could be considered as one of the best alternative for the posterior lumbar interbody fusion surgical procedure due its structural symmetry that could provide similar stability as two cages did.

Index Terms—interbody fusion, cage insertion, posterior instrumentation, cage-endplate

Cite: Muhammad Hazli Mazlan, Mitsugu Todo, Hiromitsu Takano, and Ikuho Yonezawa, "Effect of Cage Insertion Orientation on Stress Profiles and Subsidence Phenomenon in Posterior Lumbar Interbody Fusion," Journal of Medical and Bioengineering, Vol. 5, No. 2, pp. 93-97, April 2016. Doi: 10.18178/jomb.5.2.93-97
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