An analytical investigation of the mechanics of spinal instrumentation.

Three-dimensional nonlinear finite element models of the intact L4-5 one motion segment/two-vertebrae and L3-5 two motion segments/three-vertebrae were developed using computed tomography (CT) films. The finite element mesh of the L4-5 motion segment model was modified to simulate bilateral decompression surgery. The mesh was further altered to achieve stabilization, using an interbody bone graft and a set of Steffee plates and screws. The model behavior of the intact specimen in all loading modes and of the stabilized model in compression, flexion, and extension modes were studied. The stresses in the cancellous bone region were found to decrease. The interbody bone graft, due to an overall decrease in stresses in the bone below the screw, transmits about 80% of the axial load as compared with 96% transmitted by an intact disc in an intact model. Thus, the use of a fixation device induces a stress shielding effect in the vertebral body. The results indicate that although the bone graft transmits lesser loads than the intact disc, it is active in transmitting loads. The presence of low stresses in the cancellous bone region and high localized stresses in the cortical pedicle region surrounding the screw, compared with the intact case, suggests that the screws are likely to become loose over time. The use of an interbody bone graft alone or in combination with any existing fixation device also induces higher stresses at the adjacent levels. This may be responsible for the adverse iatrogenic effects seen clinically.