Skip to main content
Log in

Biomechanical Comparison of Nucleotomy with Lumbar Spine Fusion versus Nucleotomy Alone: Vibration Analysis of the Adjacent Spinal Segments

  • Regular Paper
  • Published:
International Journal of Precision Engineering and Manufacturing Aims and scope Submit manuscript

Abstract

This study aimed to investigate the effect of transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw fixation (BPSF) on dynamic responses of the adjacent spinal segments to whole body vibration (WBV) after nucleotomy. A previously validated finite element model of an intact L1-sacrum lumbar spine was modified to simulate nucleotomy with and without TLIF and BPSF at L4–L5. Transit dynamic analyses were conducted on the nucleotomy alone and the fusion models under a vertical vibration load. The computed dynamic responses for the two models at adjacent levels were recorded and compared. The results showed that at level (L5–S1) below the denucleated disc, maximum response values of the disc bulge, annulus stress and intradiscal pressure decreased due to the fusion by 5.6%, 5.2% and 7.2%, and their vibration amplitudes decreased by 30.5%, 25.7% and 24.3%. At levels (L1–L2, L2–L3 and L3–L4) above the denucleated disc, maximum response values and vibration amplitudes of the strains and stresses also produced 5.2–8.9% and 25.9–29.7% deceases due to the fusion. It implies that after nucleotomy, application of the TLIF with BPSF might be helpful to prevent negative effects of the vertical WBV on adjacent disc levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zhang, B., Xu, H., Wang, J., Liu, B., and Sun, G., “A Narrative Review of Non-Operative Treatment, Especially Traditional Chinese Medicine Therapy, for Lumbar Intervertebral Disc Herniation,” Bioscience Trends, Vol. 11, No. 4, pp. 406–417, 2017.

    Article  Google Scholar 

  2. Meakin, J. R. and Hukins, D. W L., “Effect of Removing the Nucleus Pulposus on the Deformation of the Annulus Fibrosus during Compression of the Intervertebral Disc,” Journal of Biomechanics, Vol. 33, No. 5, pp. 575–580, 2000.

    Article  Google Scholar 

  3. Frei, H., Oxland, T. R., Rathonyi, G. C., and Nolte, L.-P., “The Effect of Nucleotomy on Lumbar Spine Mechanics in Compression and Shear Loading,” Spine, Vol. 26, No. 19, pp. 2080–2089, 2001.

    Article  Google Scholar 

  4. Heuer, F., Schmidt, H., Claes, L., and Wilke, H.-J., “A New Laser Scanning Technique for Imaging Intervertebral Disc Displacement and Its Application to Modeling Nucleotomy,” Clinical Biomechanics, Vol. 23, No. 3, pp. 260–269, 2008.

    Article  Google Scholar 

  5. O’Connell, G. D., Malhotra, N. R., Vresilovic, E. J., and Elliott, D. M., “The Effect of Nucleotomy and the Dependence of Degeneration of Human Intervertebral Disc Strain in Axial Compression,” Spine, Vol. 36, No. 21, pp. 1765–1771, 2011.

    Article  Google Scholar 

  6. Putzier, M., Schneider, S. V., Funk, J. F., Tohtz, S. W., and Perka, C., “The Surgical Treatment of the Lumbar Disc Prolapse: Nucleotomy with Additional Transpedicular Dynamic Stabilization Versus Nucleotomy Alone,” Spine, Vol. 30, No. 5, pp. E109–E114, 2005.

    Article  Google Scholar 

  7. Drazin, D., Ugiliweneza, B., Al-Khouja, L., Yang, D., Johnson, P., Kim, T., and Boakye, M., “Treatment of Recurrent Disc Herniation: A Systematic Review,” Cureus, Vol. 8, No. 5, 2016.

    Google Scholar 

  8. Mobbs, R. J., Phan, K., Malham, G., Seex, K., and Rao, P. J., “Lumbar Interbody Fusion: Techniques, Indications and Comparison of Interbody Fusion Options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF,” Journal of Spine Surgery, Vol. 1, No. 1, pp. 2–8, 2015.

    Google Scholar 

  9. Ambati, D. V., Wright, E. K., Lehman, R. A., Kang, D. G., Wagner, S. C., and Dmitriev, A. E., “Bilateral Pedicle Screw Fixation Provides Superior Biomechanical Stability in Transforaminal Lumbar Interbody Fusion: A Finite Element Study,” The Spine Journal, Vol. 15, No. 8, pp. 1812–1822, 2015.

    Article  Google Scholar 

  10. Kang, K.-T., Kim, H.-J., Son, J., Yeom, J. S., and Chun, H.-J., “Comparing an Instrumented Posterior Fixation System with Rigid and Semi-Flexible Rods Using Finite Element Analysis,” International Journal of Precision Engineering and Manufacturing, Vol. 16, No. 1, pp. 163–170, 2015.

    Article  Google Scholar 

  11. Choi, H. W., Kim, Y. E., and Chae, S.-W., “Effects of the Level of Mono-Segmental Dynamic Stabilization on the Whole Lumbar Spine,” International Journal of Precision Engineering and Manufacturing, Vol. 17, No. 5, pp. 603–611, 2016.

    Article  Google Scholar 

  12. Takeshima, T., Kambara, K., Miyata, S., Ueda, Y., and Tamai, S., “Clinical and Radiographic Evaluation of Disc Excision for Lumbar Disc Herniation with and without Posterolateral Fusion,” Spine, Vol. 25, No. 4, pp. 450–456, 2000.

    Article  Google Scholar 

  13. Niemeyer, T. K., Koriller, M., Claes, L., Kettler, A., Werner, K., and Wilke, H. J., “In Vitro Study of Biomechanical Behavior of Anterior and Transforaminal Lumbar interbody Instrumentation Techniques,” Neurosurgery, Vol. 59, No. 6, pp. 1271–1277, 2006.

    Article  Google Scholar 

  14. Etebar, S. and Cahill, D. W., “Risk Factors for Adjacent-Segment Failure Following Lumbar Fixation with Rigid Instrumentation for Degenerative Instability,” Journal of Neurosurgery: Spine, Vol. 90, No. 2, pp. 163–169, 1999.

    Google Scholar 

  15. Chen, C.-S., Cheng, C.-K., Liu, C.-L., and Lo, W.-H., “Stress Analysis of the Disc Adjacent to Interbody Fusion in Lumbar Spine,” Medical Engineering & Physics, Vol. 23, No. 7, pp. 485–493, 2001.

    Article  Google Scholar 

  16. Park, P., Garton, H. J., Gala, V. C., Hoff, J. T., and McGillicuddy, J. E., “Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature,” Spine, Vol. 29, No. 17, pp. 1938–1944, 2004.

    Article  Google Scholar 

  17. Hadjipavlou, A. G., Tzermiadianos, M. N., Bogduk, N., and Zindrick, M. R., “The Pathophysiology of Disc Degeneration: A Critical Review,” The Journal of Bone and Joint Surgery. British Volume, Vol. 90, No. 10, pp. 1261–1270, 2008.

    Article  Google Scholar 

  18. Wade, K. R., Schollum, M. L., Robertson, P. A., Thambyah, A., and Broom, N. D., “ISSLS Prize Winner: Vibration Really Does Disrupt the DiscA Microanatomical Investigation,” Spine, Vol. 41, No. 15, pp. 1185–1198, 2016.

    Article  Google Scholar 

  19. Wilder, D. G. and Pope, M. H., “Epidemiological and Aetiological Aspects of Low Back Pain in Vibration Environments — An Update,” Clinical Biomechanics, Vol. 11, No. 2, pp. 61–73, 1996.

    Article  Google Scholar 

  20. Fan, W. and Guo, L.-X., “Influence of Different Frequencies of Axial Cyclic Loading on Time-Domain Vibration Response of the Lumbar Spine: A Finite Element Study,” Computers in Biology and Medicine, Vol. 86, pp. 75–81, 2017.

    Article  Google Scholar 

  21. Cheung, K. M., Karppinen, J., Chan, D., Ho, D. W. H., Song, Y.-Q., et al., “Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals,” Spine, Vol. 34, No. 9, pp. 934–940, 2009.

    Article  Google Scholar 

  22. Ruberté, L. M., Natarajan, R. N., and Andersson, G. B., “Influence of Single-Level Lumbar Degenerative Disc Disease on the Behavior of the Adjacent Segments — A Finite Element Model Study,” Journal of Biomechanics, Vol. 42, No. 3, pp. 341–348, 2009.

    Article  Google Scholar 

  23. Kim, Y.-H., Jung, T.-G., Park, E.-Y., Kang, G.-W., Kim, K.-A., and Lee, S.-J., “Biomechanical Efficacy of a Combined Interspinous Fusion System with a Lumbar Interbody Fusion Cage,” International Journal of Precision Engineering and Manufacturing, Vol. 16, No. 5, pp. 997–1001, 2015.

    Article  Google Scholar 

  24. Lee, C.-H., Kim, Y. E., Lee, H. J., Kim, D. G., and Kim, C. H., “Biomechanical Effects of Hybrid Stabilization on the Risk of Proximal Adjacent-Segment Degeneration Following Lumbar Spinal Fusion Using an Interspinous Device or a Pedicle Screw-Based Dynamic Fixator,” Journal of Neurosurgery: Spine, Vol. 27, No. 6, pp. 643–649, 2017.

    Google Scholar 

  25. Goel, V. K., Park, H., and Kong, W., “Investigation of Vibration Characteristics of the Ligamentous Lumbar Spine Using the Finite Element Approach,” Journal of Biomechanical Engineering, Vol. 116, No. 4, pp. 377–383, 1994.

    Article  Google Scholar 

  26. Xu, M., Yang, J., Lieberman, I., and Haddas, R., “Finite Element Method-Based Study for Effect of Adult Degenerative Scoliosis on the Spinal Vibration Characteristics,” Computers in Biology and Medicine, Vol. 84, No. pp. 53–58, 2017.

    Article  Google Scholar 

  27. Renner, S. M., Natarajan, R. N., Patwardhan, A. G., Havey, R. M., Voronov, L. I., et al., “Novel Model to Analyze the Effect of a Large Compressive Follower Pre-Load on Range of Motions in a Lumbar Spine,” Journal of Biomechanics, Vol. 40, No. 6, pp. 1326–1332, 2007.

    Article  Google Scholar 

  28. Shirazi-Adl, A. and Parnianpour, M., “Role of Posture in Mechanics of the Lumbar Spine in Compression,” Journal of Spinal Disorders, Vol. 9, No. 4, pp. 277–286, 1996.

    Article  Google Scholar 

  29. Guo, L., Zhang, Y.-M., and Zhang, M., “Finite Element Modeling and Modal Analysis of the Human Spine Vibration Configuration,” IEEE Transactions on Biomedical Engineering, Vol. 58, No. 10, pp. 2987–2990, 2011.

    Article  Google Scholar 

  30. Kasra, M., Shirazi-Adl, A., and Drouin, G., “Dynamics of Human Lumbar Intervertebral Joints. Experimental and Finite-Element Investigations,” Spine, Vol. 17, No. 1, pp. 93–102, 1992.

    Article  Google Scholar 

  31. Patwardhan, A. G., Havey, R. M., Meade, K. P., Lee, B., and Dunlap, B., “A Follower Load Increases the Load-Carrying Capacity of the Lumbar Spine in Compression,” Spine, Vol. 24, No. 10, pp. 1003–1009, 1999.

    Article  Google Scholar 

  32. Wilder, D. G., “On Loading of the Human Lumbar Intervertebral Motion Segment (Spine, Viscoelasticity, Vibration, Stiffness, Seating),” Ph.D. Thesis, University of Vermont, 1985.

    Google Scholar 

  33. Guo, L.-X. and Teo, E.-C., “Influence Prediction of Injury and Vibration on Adjacent Components of Spine Using Finite Element Methods,” Clinical Spine Surgery, Vol. 19, No. 2, pp. 118–124, 2006.

    Google Scholar 

  34. Kim, Y. E., Goel, V. K., Weinstein, J. N., and Lim, T. H., “Effect of Disc Degeneration at One Level on the Adjacent Level in Axial Mode,” Spine, Vol. 16, No. 3, pp. 331–335, 1991.

    Article  Google Scholar 

  35. Matsumoto, Y. and Griffin, M. J., “Non-Linear Characteristics in the Dynamic Responses of Seated Subjects Exposed to Vertical Whole-Body Vibration,” Journal of Biomechanical Engineering, Vol. 124, No. 5, pp. 527–532, 2002.

    Article  Google Scholar 

  36. Fan, W. and Guo, L.-X., “Finite Element Investigation of the Effect of Nucleus Removal on Vibration Characteristics of the Lumbar Spine under a Compressive Follower Preload,” Journal of the Mechanical Behavior of Biomedical Materials, Vol. 78, pp. 342–351, 2018.

    Article  Google Scholar 

  37. Benneker, L. M., Heini, P. F., Anderson, S. E., Alini, M., and Ito, K., “Correlation of Radiographic and MRI Parameters to Morphological and Biochemical Assessment of Intervertebral Disc Degeneration,” European Spine Journal, Vol. 14, No. 1, pp. 27–35, 2005.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Li-Xin Guo.

Additional information

Wei Fan Lecturer in the School of Mechanical Engineering and Automation, Northeastern University. His research interest is CAE analysis and Biomechanics.

Li-Xin Guo Professor in the School of Mechanical Engineering and Automation, Northeastern University. His research interest is Biomechanics, Mechanical CAE, Mechanical vibration and control and Vehicle dynamics.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fan, W., Guo, LX. Biomechanical Comparison of Nucleotomy with Lumbar Spine Fusion versus Nucleotomy Alone: Vibration Analysis of the Adjacent Spinal Segments. Int. J. Precis. Eng. Manuf. 19, 1561–1568 (2018). https://doi.org/10.1007/s12541-018-0184-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12541-018-0184-y

Keywords

Navigation