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Biomechanical and clinical studies on lumbar spine fusion surgery: a review

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Abstract

Low back pain is associated with degenerative disc diseases of the spine. Surgical treatment includes fusion and non-fusion types. The gold standard is fusion surgery, wherein the affected vertebral segment is fused. The common complication of fusion surgery is adjacent segment degeneration (ASD). The ASD often leads to revision surgery, calling for a further fusion of adjacent segments. The existing designs of nonfusion type implants are associated with clinical problems such as subsidence, difficulty in implantation, and the requirement of revision surgeries. Various surgical approaches have been adopted by the surgeons to insert the spinal implants into the affected segment. Over the years, extensive biomechanical investigations have been reported on various surgical approaches and prostheses to predict the outcomes of lumbar spine implantations. Computer models have been proven to be very effective in identifying the best prosthesis and surgical procedure. The objective of the study was to review the literature on biomechanical studies for the treatment of lumbar spinal degenerative diseases. A critical review of the clinical and biomechanical studies on fusion spine surgeries was undertaken. The important modeling parameters, challenges, and limitations of the current studies were identified, showing the future research directions.

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Abbreviations

LBP:

Low Back Pain

PS:

Pedicle Screw

FE:

Finite Element

ROM:

Ranges of Motion

RS:

Revision Surgeries

ASD:

Adjacent Segment Degeneration

ADR:

Artificial Disc Replacement

DDD:

Degenerative Disc Diseases

IVD:

Intervertebral Disc

AF:

Annulus Fibrosus

NP:

Nucleus Pulposus

CE:

Cartilaginous Endplate

BE:

Bony Endplate

3D:

Three dimensional

ALL:

Anterior Longitudinal Ligament

PLL:

Posterior Longitudinal Ligament

LF:

Ligamentum Flavum

ITL:

Inter Transverse Ligament

CL:

Capsular Ligament

ISL:

Inter Spinous Ligament

SSL:

Supra Spinous Ligament

FSU:

Functional Spinal Unit

SP:

Sagittal Plane

LSS:

Lumbar Spinal Stenosis

ISS:

Inter Spinous Spacers

LIF:

Lumbar Interbody Fusion

PLIF:

Posterior Lumbar Interbody Fusion

ALIF:

Anterior Lumbar Interbody Fusion

LLIF:

Lateral Lumbar Interbody Fusion

OLIF:

Oblique Lumbar Interbody Fusion

TLIF:

Transforaminal Lumbar Interbody Fusion

ACD:

Annular Closure Device

DIAM:

Device for Intervertebral Assisted Motion

DYNESYS:

Dynamic Neutralization System

MIS:

Minimally Invasive Surgery

BMP:

Bone Morphogenic Protein

PEEK:

Polyetherether ketone

FDA:

Food and Drug Association

UHMWPE:

Ultra High Molecular Weight Polyethylene

IDP:

Intra Discal Pressure

CT:

Computed Tomography

E:

Elastic modulus

BPS:

Bilateral Pedicle Screw

UPS:

Unilateral Pedicle Screw

AVID:

Articulating Vertebral Interbody Device

IP:

Interspinous Plate

NDT:

Non Destructive Testing

AM:

Additive Manufacturing

DALYs:

Disability-Adjusted Life Years

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Acknowledgements

The first author is thankful for the Institute Fellowship provided by the Ministry of Education, Government of India, for his Ph.D. Research at Indian Institute of Engineering Science and Technology (IIEST) Shibpur, Howrah -711103, West Bengal, India.

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    Kishore Pradeep & Bidyut Pal

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Pradeep, K., Pal, B. Biomechanical and clinical studies on lumbar spine fusion surgery: a review. Med Biol Eng Comput 61, 617–634 (2023). https://doi.org/10.1007/s11517-022-02750-6

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