Pradeep Kishore, Pal Bidyut, Mukherjee Kaushik, Shetty Gautam M
Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology (IIEST), Shibpur, Howrah, 711103, West Bengal, India.
Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110 016, India.
Heliyon. 2025 Jan 9;11(2):e41842. doi: 10.1016/j.heliyon.2025.e41842. eCollection 2025 Jan 30.
To compare the effect of minimally invasive and open transforaminal lumbar interbody fusion (TLIF) approaches in fusing the L4-L5 segment and predicting the potential risk of adjacent segment degeneration (ASD).
A computed tomography scan image was processed and the three-dimensional model of the L1-L5 spine was reconstructed. The minimally invasive and Open TLIF finite element models were constructed. The models were analyzed using an axial compressive load (500 N) and physiological movements like flexion, extension, and lateral bending with a combined load and moment (150 N and 10 Nm). The ranges of motion (ROM), stress-strain distributions on the L4-L5 implanted segment and cranial adjacent soft structures were compared with the intact model.
A substantially comparable drop in ROM was observed for both models due to implantation. The stress and strain distributions on the implanted segment of both models were nearly identical. The peak strain on the L4-L5 was higher than 0.007 for both models. The maximum stress and strain observed on adjacent segment soft structures, except for the annulus fibrosus of both the implanted models, were substantially higher than the intact structures.
The open and MI-TLIF approaches are effective in reducing ROMs. However, the higher stress and strain on the L4-L5 segment indicate the chances of bone failure. The higher stress and strain on the adjacent segment soft structures indicate the potential risk of ASD in both models. However, considering the lower intrusive nature of the MI-TLIF technique, it might be favoured over Open TLIF.
比较微创和开放经椎间孔腰椎椎间融合术（TLIF）治疗L4-L5节段融合的效果，并预测相邻节段退变（ASD）的潜在风险。
对计算机断层扫描图像进行处理，重建L1-L5脊柱的三维模型。构建微创和开放TLIF有限元模型。使用轴向压缩载荷（500 N）以及屈曲、伸展和侧屈等生理运动并结合载荷和力矩（150 N和10 Nm）对模型进行分析。将L4-L5植入节段及上位相邻软组织结构的活动范围（ROM）、应力-应变分布与完整模型进行比较。
由于植入，两种模型的ROM均出现了大幅可比的下降。两种模型植入节段的应力和应变分布几乎相同。两种模型L4-L5节段的峰值应变均高于0.007。除植入模型的纤维环外，在相邻节段软组织结构上观察到的最大应力和应变显著高于完整结构。
开放和微创TLIF方法在减少ROM方面均有效。然而，L4-L5节段较高的应力和应变表明存在骨破坏的可能性。相邻节段软组织结构上较高的应力和应变表明两种模型均存在ASD的潜在风险。然而，考虑到微创TLIF技术的侵入性较低，它可能比开放TLIF更具优势。
