The Optimum Cage Position and Orientation on the ALIF with Facet Screw Fixation: A Finite Element Analysis and the Taguchi Method

Anterior Lumbar Interbody Fusion (ALIF) has been widely used to treat internal disc degeneration. However, different cage positions and their orientations may affect the initial stability leading to different fusion results. The purpose of the present study is to investigate the optimum cage position and orientation for aiding an ALIF having a transfacet pedicle screw fixation (TFPS). A three-dimensional finite element model (ALIF with TFPS) has been developed to simulate the stability of the L4/L5 fusion segment under five different loading conditions. The Taguchi method was used to evaluate the optimized placement of the cages. Three control factors and two noise factors were included in the parameter design. The control factors included the anterior-posterior position, the medio-lateral position, and the convergent-divergent angle between the two cages. The compressive preload and the strengths of the cancellous bone were set as noise factors. From the results of the FEA and the Taguchi method, we suggest that the optimal cage positioning has a wide anterior placement, and a diverging angle between the two cages. The results show that the optimum cage position simultaneously contributes to a stronger support of the anterior column and lowers the risk of TFPS loosening.