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BACKGROUND: At present, lumbar interbody fusion is widely used in the treatment of a variety of lumbar diseases. However, how to reduce postoperative complications such as pseudarthrosis formation, screw loosening and fracture, and cage failure remains a serious challenge. OBJECTIVE: To analyze the effect of total lumbar range of motion on the stress or strain of bone grafts, cage, and screw-rod system, so as to better guide patients to carry out lumbar activities to reduce the risks of pseudarthrosis formation and instrumentation failure. METHODS: An intact human L1-S1 finite element model was constructed using Mimics, 3-Matic, HyperMesh, and Abaqus software and the transforaminal lumbar interbody fusion was simulated. The average strain of the interbody bone grafts and the peak stresses of the cage and screw-rod system were compared before and after applying the bending moment, and the changing trend with the total range of motion was analyzed. The stress nephogram was drawn to observe the stress distribution. RESULTS AND CONCLUSION: (1) Compared with applying the vertical compression load alone, the average strain of the interbody bone grafts, peak stresses of the cage and screw-rod system after applying bending moment increased by 2.6%-55.3%, 65.6%-166.8%, and 36.0%-353.4%, respectively. (2) With the increase of total range of motion, the average strain of the interbody bone grafts increased nonlinearly and produced the maximum value under left and right axial rotation, while the peak stresses of the cage and screw-rod system increased linearly and produced the maximum value under left and right lateral bending. (3) The stress distribution of the interbody bone grafts and cage was related to the loading condition. The stress of the screw-rod system was mainly concentrated in the interfaces of the screw-bone and screw-rod. (4) Therefore, increasing axial rotation activity after operation may reduce the risk of pseudarthrosis formation, while reducing lateral bending activity may reduce the failure of the cage and screw-rod system [ABSTRACT FROM AUTHOR]

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BACKGROUND: Polyetheretherketone rod is a new material for semi-rigid fixation; however, its biomechanical properties in posterior lumbar interbody fusion remain unclear. OBJECTIVE: To compare the biomechanical properties of polyetheretherketone rods and titanium rods in posterior lumbar interbody fusion, and try to answer whether polyetheretherketone rods have the potential to be a substitute for titanium rods, especially when the anterior column of the spine is not adequately supported. METHODS: An intact L3-5 lumbar model was constructed using the finite element method. The four posterior lumbar interbody fusion constructs were developed: (1) polyetheretherketone rods with cage; (2) titanium rods with cage; (3) polyetheretherketone rods with bone grafts alone; and (4) titanium rods with bone grafts alone. The range of motion, stress and strain of the related structures were compared among the four posterior lumbar interbody fusion constructs. RESULTS AND CONCLUSION: (1) There was no significant difference in the L4/5 range of motion among all surgical models. (2) Compared to titanium rods, polyetheretherketone rods increased the average strain of interbody bone grafts and the peak stresses of endplates and cages and reduced the peak stresses of the screws and bone-screw interfaces. The ratio of peak stress to yield stress for the polyetheretherketone rods (6%–26%) was higher than that for the titanium rods (3%–12%). (3) Polyetheretherketone rods only slightly reduced the range of motion and disc stress at the L3/4 segment. (4) Compared to titanium rods, polyetheretherketone rods maybe reduce the risks of pseudoarthroses, screw breaking, and loosening but lead to the higher risks of endplate collapse, cage failure, and rod fracture. Polyetheretherketone rods may have a weak advantage over titanium rods in retarding adjacent segment degeneration. Polyetheretherketone rods may be an alternative when interbody fusion is performed with bone grafts alone instead of cages. [ABSTRACT FROM AUTHOR]

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