Posterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion: Finite Element Analysis of the Vibration Characteristics of Fused Lumbar Spine

Abstract

Previous studies have investigated biomechanical characteristics of the lumbar spine after different types of lumbar interbody fusion surgery under static loadings. However, very few have dealt with the whole-body vibration (WBV) condition that is typically present in vehicles. The aim of this study was to compare the influence of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) on dynamic responses of the fused lumbar spine to vertical WBV. The PLIF and TLIF procedures with bilateral pedicle screw fixation at L4-L5 level were simulated by modifying a previously validated intact lumbar L1-S1 finite element model. The PLIF and TLIF models were subjected to a sinusoidal vertical load with a compressive follower preload, and computed for transient dynamic analysis. The obtained dynamic responses for the models at the fused and adjacent levels were collected and compared. The results showed that the contact force between endplate and cage was higher in the PLIF model than in the TLIF model, indicating that PLIF allowed for higher compressive load across the anterior structure. At fused L4-L5 level, the TLIF led to a higher stress in the endplate and posterior BPSF system than the PLIF. At adjacent L3-L4 level and L5-S1 level, the computed dynamic responses, in terms of stress and deformation, for the PLIF and TLIF models showed very few differences. This study may be helpful to quantify dynamic mechanical properties of the fused lumbar spine, and better understand biomechanical differences between the PLIF and TLIF procedures during vibration.